RT Journal Article
SR Electronic
T1 How does the ‘Heart Team’ decision get enacted for patients with coronary artery disease?
JF Heart Asia
FD BMJ Publishing Group Ltd, British Cardiovascular Society and Asia Pacific Heart Association
SP 31
OP 33
DO 10.1136/heartasia-2013-010477
VO 6
IS 1
A1 Pankaj Kumar Mishra
A1 Heyman Luckraz
A1 Dincer Aktuerk
A1 Joyce Thekkudan
A1 Sophia Mahboob
A1 Mike Norell
YR 2014
UL http://heartasia.bmj.com/content/6/1/31.abstract
AB Objectives A heart team approach has been recommended for managing patients with coronary artery disease. Although this seems to be a new concept, we have been developing such a practice for over 8 years. In this report, the enactment of the heart team decision is reviewed and possible improvement is discussed. Design Review of 1000 heart team decisions over a 1-year period for patients with coronary artery disease. These decisions were recorded contemporaneously at the time of the team discussion. Thereafter, patient's notes were reviewed 6 months following the heart team meeting to assess whether the decision was enacted and, if not, what were the reasons for aberration. Results The heart team decision was enacted in 95.5% of patients. The reasons for aberration in the remaining 45 patients included patient's choice (refusal), unrecognised comorbidities at the time of the heart team discussion, change in patient's clinical condition requiring urgent intervention and death while awaiting procedure, among others. Conclusions The decision of a well set-up heartteam meeting is carried out for most patients. Aberration is uncommon and usually due to unknown factors at the time of the discussion. The heart team approach ensures that patients receive best available care (most likely evidence-based), and demonstrates transparency.