Hotline 24/7: 0909384389

Share links:

Heart teams and interventional cardiologists often differ over recommendations for multivessel CAD

Ngày 21/08/2020 10:19 | Lượt xem: 822

A study comparing recommendations from a heart team versus those of an interventional cardiologist for the treatment of patients with multivessel coronary artery disease (CAD) has found differing recommendations in up to one-third of cases.

According to the author of the study published in JAMA: Network OpenMichael B Tsang (Department of Medicine, McMaster University, St Catharines, Canada), this subset of cases was associated with a greater number of divergent opinions between interventional cardiologists and within the heart team.

The study enrolled 245 consecutive patients with multivessel CAD from a high-volume tertiary care referral centre, 185 of whom were patients were enrolled through a screening process, and 60 patients were retrospectively enrolled from the centre’s database. A total of 237 patients were included in the final virtual heart team analysis.

Treatment decisions—which comprised coronary artery bypass grafting, percutaneous coronary intervention, and medication therapy—were made by the original treating interventional cardiologists between March 15 2012 and October 20 2014. These decisions were then compared with pooled-majority treatment decisions made by eight blinded heart teams using structured online case presentations between October 1 2017, and October 15 2018.

The randomised members of the heart teams comprised experts from three domains, with each team containing one non-invasive cardiologist, one interventional cardiologist, and one cardiovascular surgeon.

Cases in which all three of the heart team members disagreed and cases in which procedural discordance occurred were discussed in a face-to-face heart team review in October 2018 to obtain pooled-majority decisions. Data were analysed from May 6 2019 to April 22 2020.

Among 234 of 237 patients (98.7%) in the analysis for whom complete data were available, the mean age was 67.8 (10.9) years, 176 patients (75.2%) were male, and 191 patients (81.4%) had stenosis in three epicardial coronary vessels. A total of 71 differences (30.3%; 95% CI, 24.5%‒36.7%) in treatment decisions between the heart team and the original treating interventional cardiologist occurred, with a Cohen κ of 0.478 (95% CI, 0.336-0.540; p=0.006).

The heart team decision was more frequently unanimous when it was concordant with the decision of the original treating interventional cardiologist (109 of 163 cases [66.9%]) compared with when it was discordant (28 of 71 cases [39.4%]; p<0.001). When the heart team agreed with the original treatment decision, there was more agreement between the heart team interventional cardiologist and the original treating interventional cardiologist (138 of 163 cases [84.7%]) compared with when the heart team disagreed with the original treatment decision (14 of 71 cases [19.7%]); p<0.001), Tsang and colleagues found.

Those with an original treatment of coronary artery bypass grafting, percutaneous coronary intervention, and medication therapy, 32 of 148 patients [22.3%], 32 of 71 patients [45.1%], and 6 of 15 patients [40.0%], respectively, received a different treatment recommendation from the heart team than the original treating interventional cardiologist; the difference across the three groups was statistically significant (p=0.002).

Tsang and colleagues conclude that the heart team’s recommended treatment for patients with multivessel coronary artery disease differed from that of the original treating interventional cardiologist in up to 30% of cases. This subset of cases, they note, “was associated with a lower frequency of unanimous decisions within the heart team and less concordance between the interventional cardiologists; discordance was more frequent when percutaneous coronary intervention or medication therapy were considered.”

Tsang and colleagues add that  Further research is needed to evaluate whether heart team decisions are associated with improvements in outcomes and, if so, how to identify patients for whom the heart team approach would be beneficial.

Source CardiovascularNews

Duc Tin Clinic

Tin tức liên quan

Enrolment reaches midway point in trial of Early Bird bleed monitoring system

Eight-fold increased risk of heart attack seen in patients with subclinical obstructive coronary atherosclerosis

ACC 2023: REVIVED-BCIS-2 results challenge “long-held beliefs” on myocardial viability testing prior to PCI

Blood pressure successfully cut in RADIANCE II ultrasound renal denervation trial

New data examine mortality rates and cardiac damage in early-stage aortic stenosis patients

SUPPORT CONSULTANT

CUSTOMER REVIEWS

• I am Nguyen Thanh Sang, born in 1990. Since the examination and treatment at the clinic Duc Tin, I am very grateful to the Doctor for explaining and sharing about my illness. During the treatment time in the clinic I was very caring staff of the clinic. Now my illness has improved in a good way. Expect more and more clinic to be able to save many patients.

  I sincerely thank you !. Tel: 0938303275

• Huynh Thi Muoi, born in 1940, was examined and treated at Duc Tin Clinic. I am very pleased about how to serve and care patients of the clinic. The doctor is committed to explaining and sharing with the patient.

  Huynh Thi Muoi sincerely thank you! Phone number: 0972868746

• As I said Duc Tin surgical clinin is where my family trust, hope to visit. Physicians caring, thoughtful, gentle to the patient. Nurses and staff clinic polite, cheerful and thoughtful. This clinic clean, sterile, so I would love to. Tel: +84949914060.

• The doctor is very caring, attentive and very gentle nurse, courteous, affable with me. The clinic is clean, comfortable, polite. I enjoyed this faith. Every visit I was very relieved disease. Tel: 0839820792.

• I was patient, had to clinics of Dr. Le Duc Tin. I see very conscientious doctor patient care, answer any questions and very dedicated staff from the receptionist to the children tested, nursing. Clinics very clean and spacious. I'm very satisfied. Tel: +841227880829.

Search

News

Customer support