June 25, 2018
For decades, medical care in America has been about going to see “the doctor” for a specific problem. If you had a rash, you saw the dermatologist. If you had reflux, you saw the gastroenterologist, and so forth. In many industries, however, problems are often solved by teams of individuals with varying expertise, working together to achieve a solution. This concept has finally come to the world of medicine, particularly in the treatment of heart disease.
A heart team’s composition can vary; in most hospitals, it includes cardiac surgeons, cardiologists and their subspecialists, case managers, data managers, catheterization laboratory team members, operating room staff, advanced practice professionals (physician assistants and nurse practitioners), and possibly representatives from the hospital administration. Heart team members may meet regularly during a set conference or come together when the clinical situation requires, offering their expertise on complex patient problems.
Examples of a heart team approach may involve helping patients with advanced coronary artery disease and their families decide whether stents or bypass surgery is the better option. The heart team may also offer insight into whether a patient should be offered transcatheter aortic valve replacement (TAVR), minimally invasive valve surgery, or a standard open aortic valve surgery. Or, the team may even come up with novel approaches that involve combinations of procedures that one doctor may not have considered. Sometimes, the consensus is that no procedure should be performed and that taking medicine is the best route.
If you already have a heart doctor who you trust, you may wonder “why a heart team?” As patients and their conditions become more complex and more advanced treatment options develop, a team approach allows a more comprehensive look at a patient’s problem. Whereas a single doctor may not always be aware of possible solutions that other doctors might suggest for a patient’s condition.
As an example, I recently saw a patient who was referred to me for bypass surgery after her cardiologist found blockages in several vessels. Upon further evaluation, I discovered that, in addition to her blockages, she had a leaking mitral valve. And because her lungs were so damaged by years of smoking, she was at high risk of not coming off the ventilator if she had surgery. I presented her case to our heart team, and we concluded that the best approach for this patient was the placement of stents in her two most diseased arteries to treat the blockages followed by a reevaluation. If the valve was still badly leaking after the stents, the team decided that the safest option for this patient was a newer procedure that allows the valve to be “clipped” in order to reduce the leak. Neither her original heart doctor nor I—on our own—would have been able to design that strategy for the patient. But the heart team did!
As a patient, you should feel comfortable asking if there are other treatment options available and if your problem merits being discussed by a team of doctors, especially if you face a complex condition.
The opinions expressed in this article are those of the author and do not necessarily reflect the views of The Society of Thoracic Surgeons.
The STS mission is to advance cardiothoracic surgeons’ delivery of the highest quality patient care through collaboration, education, research, and advocacy.