Ma Hanping, Lin Shen, Li Xi, Wang Yang, Yang Weixian, Dou Kefei, Liu Sheng, Zheng Zhe
National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Interdiscip Cardiovasc Thorac Surg. 2025 Feb 5;40(2). doi: 10.1093/icvts/ivaf023.
A lack of standardization in heart team implementation potentially leads to suboptimal decision-making quality, and we previously established a modified heart team protocol to improve the decision-making quality. The present trial was to validate the effect of the modified heart team implementation protocol on improving the decision-making quality versus the conventional protocol in complex coronary artery disease (CAD).
Eligible interventional cardiologists, cardiac surgeons and non-interventional cardiologists were randomly allocated to the intervention or control arm and established 12 heart teams in each arm. The 12 heart teams in each arm were randomly divided into 6 pairs, and 480 historic cases with complex CAD into 6 sets of 80 cases. In each arm, each set of 80 cases was discussed independently by one pair of heart teams, with each case finally receiving two heart team decisions ('pairwise decisions'). The intervention arm conducted heart team decision-making according to the previously established protocol and the control arm based on guideline recommendations. The primary outcome was the overall percent agreement of the inter-team pairwise decisions. Decision-making appropriateness was further analysed.
A total of 36 cardiac surgeons, 36 interventional cardiologists and 12 non-interventional cardiologists from 26 centres were enrolled. The overall percent agreement was significantly higher in the intervention arm than the control arm (72.1% vs 65.8%, P = 0.04; kappa 0.51 vs 0.37). Both team-level (19.4% vs 33.0%; P < 0.001) and specialist-level (interventional cardiologists, 19.8% vs 37.7%, P < 0.001; cardiac surgeons, 19.8% vs 28.7%, P < 0.001) inappropriateness rate of decision-making was significantly lower in the intervention arm than the control arm.
The modified heart team implementation protocol improved the decision-making quality and appropriateness compared with the guideline-based protocol.
心脏团队实施过程中缺乏标准化可能导致决策质量欠佳，我们之前制定了一种改良的心脏团队方案以提高决策质量。本试验旨在验证改良的心脏团队实施方案与传统方案相比，对改善复杂冠状动脉疾病（CAD）决策质量的效果。
符合条件的介入心脏病学家、心脏外科医生和非介入心脏病学家被随机分配至干预组或对照组，每组组建12个心脏团队。每组的12个心脏团队被随机分成6对，480例复杂CAD历史病例被分成6组，每组80例。在每组中，每组80例病例由一对心脏团队独立讨论，每个病例最终获得两个心脏团队的决策（“成对决策”）。干预组根据先前制定的方案进行心脏团队决策，对照组则基于指南建议进行决策。主要结局是团队间成对决策的总体一致率。进一步分析决策的适宜性。
来自26个中心的36名心脏外科医生、36名介入心脏病学家和12名非介入心脏病学家参与了研究。干预组的总体一致率显著高于对照组（72.1%对65.8%，P = 0.04；kappa值为0.51对0.37）。干预组的团队层面（19.4%对33.0%；P < 0.001）和专家层面（介入心脏病学家，19.8%对37.7%，P < 0.001；心脏外科医生，19.8%对28.7%，P < 0.001）决策不当率均显著低于对照组。
与基于指南的方案相比，改良的心脏团队实施方案提高了决策质量和适宜性。
