The current state of the multidisciplinary heart team approach: a systematic review

Abstract

The heart team (HT) approach, recommended for managing cardiovascular diseases, emphasizes multidisciplinary collaboration. Despite its potential benefits, evidence on its effectiveness and implementation is varied and sparse. This review assesses the HT approach's impact on patient outcomes and care delivery in cardiovascular care. A systematic review was conducted across MEDLINE, EMBASE, PubMed, Cochrane and Google Scholar up to July 2023, focusing on studies that implemented an HT approach in coronary and heart valve disease management. Exclusion criteria included non-human studies, case reports and studies not focusing on HT outcomes. From 6270 identified articles, 20 met the inclusion criteria. These studies demonstrated significant variability in HT composition and organization, coupled with a lack of standardized metrics for evaluating clinical outcomes and the impact of the HT. Significant variability was observed in HT composition, with 13 of the 20 studies did not utilize structured templates, those that did demonstrated more consistent decision-making. In mitral valve interventions, HTs were linked to reduced in-hospital mortality and improved long-term survival (5-year survival probability of 0.74 vs 0.70, P = 0.04). In aortic valve interventions, 80% of patients underwent tailored valve procedures following HT evaluation. The HT approach in cardiovascular care demonstrates improved patient outcomes, particularly in specialized interventions for mitral and aortic valve diseases and coronary artery disease management. Despite these positive findings, the variability in HT implementation and the need for standardized outcome metrics call for further advances to optimize this collaborative care model.

Keywords: Aortic Valve Interventions; Cardiovascular Diseases (CVDs); Coronary Artery Disease (CAD); Mitral Valve Interventions; Multidisciplinary Heart Team (HT); Standardized Outcome Metrics.

Graphical abstract

Figure 1:

Risk of bias analysis. D1: deviation from intended intervention; D2: missing outcome data; D3: measurement of outcome; D4: selective reporting; classified as low risk of bias, some concerns or high risk of bias.

Figure 2:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Tree illustrating the systematic search and paper selection.

Figure 3:

Five key steps on how to provide a structured heart team approach.

Figure 4:

Illustration of the main topics surrounding the heart team discussed in the manuscript.