Propensity Score Analysis Supports the Benefit of the Heart Team Meeting on Mortality in High-Risk Cardiac Surgery

Abstract

Introduction: The Heart Team (HT) is a multidisciplinary team that advises on optimisation and management of complex patients. There is limited evidence about the effects of the HT on high-risk cardiac surgery patients. Methods: The study population included cardiac patients operated at Liverpool Hospital or referred to the HT between 2013 and 2014. Patients’ mortality risks were estimated using existing risk scoring models (RSM). High-risk patients were identified using the high-risk cut-off point derived from the RSM analysis in a separate study. Propensity score matching was performed for the high-risk cohorts and the effect of the HT for the matched populations was examined. Compliance to the HT recommendations was reported. Results: Compliance to recommendations was 78.5%. Overall, 898 surgical patients were used for the HT analysis. Two high-risk cohorts were formed using high-risk cut-off points for EuroSCORE II (ES2≥3, n = 249) and Society of Thoracic Surgeon score (STS≥1.705, n = 241). Forty-three and 35 matched pairs between the HT and the non-HT cohort were obtained for the ES2 and STS high-risk cohort respectively. A trend to decrease mortality was observed between matched HT and non-HT high-risk ES2 cohort (16.0% vs 23.0%; p = 0.510) and number needed to discuss was 14.3 to save one mortality. Conclusion: Analysis of propensity score matched cohorts showed an acceptable number needed to treat and evidence supported the HT benefit. The HT should be used when managing complex cardiac surgery patients in order to provide an equipoised evidenced-based clinical decision tailored to the needs of the patient.