Arjomandi Rad Arian, Streukens Sebastian, Vainer Jindra, Athanasiou Thanos, Maessen Jos, Sardari Nia Peyman
Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Cardiothoracic Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK.
Eur J Cardiothorac Surg. 2024 Dec 26;67(1). doi: 10.1093/ejcts/ezae461.
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.
心脏团队(HT)方法被推荐用于管理心血管疾病,强调多学科协作。尽管有潜在益处,但其有效性和实施方面的证据参差不齐且较为稀少。本综述评估了HT方法对心血管护理中患者结局和护理提供的影响。截至2023年7月,在MEDLINE、EMBASE、PubMed、Cochrane和谷歌学术上进行了系统综述,重点关注在冠状动脉和心脏瓣膜疾病管理中实施HT方法的研究。排除标准包括非人类研究、病例报告以及未关注HT结局的研究。从6270篇已识别的文章中,20篇符合纳入标准。这些研究表明,HT的组成和组织存在显著差异,同时缺乏评估临床结局和HT影响的标准化指标。在HT组成方面观察到显著差异,20项研究中有13项未使用结构化模板,使用结构化模板的研究决策更一致。在二尖瓣干预中,HT与降低住院死亡率和改善长期生存率相关(5年生存概率为0.74对0.70,P = 0.04)。在主动脉瓣干预中,80%的患者在HT评估后接受了量身定制的瓣膜手术。心血管护理中的HT方法显示出患者结局得到改善,特别是在二尖瓣和主动脉瓣疾病以及冠状动脉疾病管理的专科干预中。尽管有这些积极发现,但HT实施的差异以及对标准化结局指标的需求要求进一步改进,以优化这种协作护理模式。