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Riojas et al. Vessel Plus 2024;8:6 https://dx.doi.org/10.20517/2574-1209.2023.122 Page 7 of 16

[41]
Figure 1. The “Five Star” model, adapted from Lee et al., is depicted here and has five steps to operationalizing a heart team . These
steps are intended for broad use to guide the formation of an effective heart team.
There may also be less participation in large online meetings versus face-to-face meetings, and institutions
with limited technology support may have difficulty arranging online meetings . The solution may be a
[44]
hybrid approach where participants have the option of online versus in-person meetings.

Previously, one barrier to presenting patients may have been discussing patients of physicians not part of
the primary institution, such as a primary cardiologist from a private practice group. Should the referring
physicians from outside hospitals present the patients? How is the final recommendation of the heart team
relayed back to the referring physician? Some of these communication barriers have been alleviated in
recent years with the use of web-based platforms , where a link can be sent to the outside referring
[43]
physicians. If they do not participate, then one of the heart team members should inform the referring
physician of the multidisciplinary recommendation, while taking the patient’s preference into
[39]
consideration .

One of the unique challenges in cardiovascular medicine is creating a balance between formulating a
treatment plan and treating a patient in a timely fashion . For example, a clinician may decide to perform
[18]
PCI immediately after a diagnostic angiogram. Recently, a retrospective review of patients in the state of
New York from 2017 to 2019 found that ad hoc PCI was still performed at a high rate, including 78% of
patients with multivessel or left main coronary artery disease, 76% of patients with 3-vessel disease, and 75%
of patients with diabetes . Some of the arguments for ad hoc PCI may be a shorter time to
[14]
revascularization, non-availability of cardiac surgery, patient preference, or other reasons. However, it may