EditorialThe Heart Team Approach to Coronary Revascularization—Have We Crossed the Lines of Evidence-Based Medicine?
Section snippets
From Evidence-Based Medicine to the Heart Team Approach
Clinical judgment is based on both available relevant data and the decision-making process. The shift in recent decades to “evidence-based medicine” demands considerable time to navigate through the proliferating data. The need to identify and categorize data that influence clinical decision making has become a Sisyphean struggle for the practicing physician. As a result, a hierarchical “pyramid of evidence” has been formulated to help categorize data quality (Figure 1).1 To further assist and
Is There a Need to Optimize the Revascularization Decision-Making Process?
In the last decade, “the PCI era”, PCI has evolved into the most common in hospital procedures followed by a dramatic reduction in mortality in CAD, mostly in patients with acute myocardial infarction.
Two retrospective analyses of large registries have examined adherence by current methods of decision making to PGs. Anderson et al,9 in a retrospective analysis of 412,617 PCIs in the ACC National Cardiovascular Registry, found that only 8% of the PCIs were performed in class 3 indication whereas
Is the Heart Team Approach Supported by the Contemporary Science of Decision Making?
As for the optimal method for decision making, the complex issue of optimal decision making and judgment under uncertainty, for which the solution of the heart team approach was proposed, has been studied extensively in the last 4 decades.
In 2002, Daniel Kahneman was awarded the Nobel Prize for his landmark studies on human biases in judgment and decision making. His seminal work, together with the late Amos Tversky, illuminated the way that inherent and consistent patterns of cognition lead to
Disclosures
The authors have no conflicts of interest to disclose.
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Cited by (14)
Does a Heart Team Improve Clinical Outcomes?
2022, American Journal of CardiologyCitation Excerpt :With the advent of the HT, we have potentially crossed the line of evidence-based medicine. Currently, it is an extrapolation of a research method of patient recruitment that is being brought into broad clinical practice.5 The current evidence for the use of HT comes from multidisciplinary teams in cancer care.
Identification of candidates for coronary artery bypass grafting admitted with STEMI and Multivessel Disease
2018, Cardiovascular Revascularization MedicineCitation Excerpt :The higher residual SYNTAX score in the left coronary artery, and the lower infarct-related SYNTAX when the RCA is the culprit vessel may define this population as possible ideal candidates for CSR after provisional percutaneous revascularization without stent implantation, provided that the surgical risk is not high and an ad-hoc heart team has agreed that this approach is the best for the affected patient. Since surgical risk scores have limited accuracy to predict outcomes after CABG, especially when a percutaneous intervention has been previously performed [27], we simulated a heart-team after the patient was treated (post hoc heart-team) [28]. We discussed what would have been our treatment choice after the patient had the culprit vessel opened, before stent implantation, and if the patient had been in a stable setting.
Implementation and consistency of Heart Team decision-making in complex coronary revascularisation
2016, International Journal of CardiologyCitation Excerpt :Although the HT concept has now been widely accepted by the scientific community, data for its adoption and implementation in every day practise are scarce. Studies that evaluate its pros and cons and especially the reproducibility of its results are important in order to validate its concept [24–25]. The purpose of this study was to evaluate the implementation and consistency of coronary HT decisions in a tertiary cardiac centre.
A call for an evidence-based approach to the heart team for patients with severe aortic stenosis
2015, Journal of the American College of CardiologyClinical Impact of Heart Team Decisions for Patients With Complex Valvular Heart Disease: A Large, Single-Center Experience
2022, Journal of the American Heart Association
Drs. Rosenschein and Nagler contributed equally to this work.