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

Figure 2. Evolution of the Heart Team: the heart team has evolved from a core group of members, which typically included an
interventional cardiologist, cardiac surgeon, and the referring cardiologist or other physician. Current multidisciplinary heart teams may
include additional medical and surgical consultants, specialized cardiologists, such as heart failure and echocardiography, intensivists,
advanced practice providers (APP’s), clinical pharmacists, nutritionists, social workers, and others as needed to provide a more holistic,
patient-centered approach to the decision-making process.

be beneficial to seek the viewpoints and input of a multidisciplinary team in the setting of complex coronary
[18]
artery disease . The effect is a delay in treatment. In fact, one group found an average delay of 7 days to
PCI when a heart team was used . Although they did not evaluate whether this delay led to adverse
[48]
outcomes during the waiting period, they surmised that, based on other studies, delay in treatment could
lead to increased major events prior to revascularization. The group from Erasmus University Medical
Center in the Netherlands reported their utilization of the Heart team . They held a daily meeting for
[39]
30 min to discuss all patients with CAD, including patients from their own institutions and from
community hospitals. The median interval to review a patient from the time of referral was 2 days. The
median interval to treatment was 12 days. Thus, not only did they demonstrate feasibility, but the safety of
the heart team. In terms of timing, some hurdles may be difficult to avoid, such as when holidays or other
important meetings supercede that of the heart team. There should be another mechanism for discussing
patients in these situations, such as direct phone calls arranged to include the primary cardiologist, the
interventional cardiologist, and the cardiac surgeon. The goal should be to identify which patients might
have a survival advantage with a different treatment option, whether it is PCI, optimal medical therapy, or
CABG surgery, and which can be achieved through a heart team consultation and shared decision
[14]
making .

Another major barrier is how to get the same benefit of the multidisciplinary discussion in an acute setting,
such as a patient in cardiogenic shock, or on the weekends. One option is to create an emergent conference
call or email chain where representatives from cardiology, surgery and the intensive care unit can discuss
these patients and make a decision expeditiously. In tertiary care centers, a cardiogenic shock team may
respond to these patients. Similar to the heart team, the shock team will have providers from ICU,
interventional cardiology, cardiac surgery, and advanced cardiomyopathy services. The shock team can
discuss immediate treatment options, resuscitation goals, advanced therapies, and revascularization options