Abstract 154: Prevalence of Heart Team Decision-Making at Hospitals in Michigan

Abstract

BACKGROUND: Heart Team decision-making for patients with complex coronary disease is a new concept in patient management, increasingly supported by guidelines. Although the Heart Team concept is supported by theory, there are little real-world data on implementation and prevalence. We sought to assess the prevalence of Heart Teams, and their impact on collaborative practice. METHODS: The Blue Cross Blue Shield of Michigan Cardiovascular Consortium and Michigan Society of Thoracic and Cardiovascular Surgeons performed a survey of 31 hospitals in Michigan where percutaneous coronary intervention (PCI) is performed. This survey was performed in 5/2011, before Heart Teams were recommended in National Guidelines. Physicians from each hospital were asked about the presence of a Heart Team or Case Conference, the frequency of collaboration, and the subjective level of collaboration (using a five-point Likert-type scale). We assessed the level of agreement between respondents from the same hospital about whether a Heart Team was active at their hospital. Due to disagreement at several hospitals, we classified them into Definite, Possible, or No Heart Team groups. RESULTS: Fifty-three physicians responded, representing 27/31 (87.1%) of hospitals surveyed. Seven hospitals out of 27 (25.9%) reported either a Heart Team or combined Case Conference, while 11/27 hospitals (40.7%) reported no Heart Team or Case Conference. There was disagreement about the presence of a Heart Team at 7/27 (25.9%) of hospitals and about Case Conferences at 9/27 (33.3%) of hospitals. There were few significant differences in the size or characteristics of hospitals between Heart Team groups. All Heart Team hospitals were teaching hospitals, compared with 73% (8/11) of non-Heart Team hospitals (p=0.056). The reported level of collaboration was significantly higher at Heart Team hospitals; this was reported as very good or best possible (4 or 5 out of 5) by 83.8% (31/37) of possible or definite Heart Team hospital respondents, compared with 50% (8/16) of respondents from hospitals without Heart Teams (p=0.017). Communication about patients undergoing multivessel PCI was higher at Heart Team hospitals (p=0.005). Discussion: This is the first report on the prevalence of Heart Teams in real-world practice, prior to the release of guidelines supporting their implementation. The most important findings of this study are the low initial prevalence of Heart Teams, and the level of disagreement between survey respondents about whether their hospital has a Heart Team or Case Conference. The survey shows higher levels of collaboration at hospitals with Heart Teams or Case Conferences. As Heart Teams become more widespread, more formal definition of the implementation and activities of a Heart Team will be crucial. Further study is needed to clarify the institutional characteristics that lead to a successful Heart Team.