The Spectrum Health Heart Team, formed in 2015, represents a true collaboration between cardiothoracic surgeons, interventional cardiologists, heart failure specialists, cardiac anesthesiologists, advanced imaging specialists, and intensivists. Each week, the team of 20 to 25 physicians, along with nurses and physician assistants, meets to review challenging cases with the goal of determining the best treatment course for each patient. By reviewing patients from a multidisciplinary perspective, we have a thorough discussion of the risks and benefits of each proposed treatment and communicate the best alternatives to our patients for an optimal outcome that meets their personal goals. Our heart team coordinator continues to oversee and coordinate care throughout their course.

When patients are referred for Protected percutaneous coronary intervention (PCI), our dedicated coordinator helps to navigate their treatment, similar to the role of a transcatheter aortic valve replacement coordinator. Our Protected PCI coordinator’s responsibilities include managing the relationship with the referring physician, coordinating the procedure and follow-up appointments, and answering patient questions.

MULTIDISCIPLINARY HEART TEAM: CHANGING THE CARE PARADIGM

The multidisciplinary team came together at Spectrum Health to address the challenges of treating complex patients and streamlining the treatment paths they may follow. We routinely evaluate patients presenting with cardiogenic shock, congestive heart failure, left ventricular dysfunction, and those with chronic total occlusions or other patients who would be considered high-risk for revascularization. Our mission is to connect patients with the right providers and procedures. This approach is changing the paradigm given that a large group weighs in on the individual patient, with a goal of achieving the optimum care that meets patient goals. Patient-centered, shared decision-making that respects and understands patient goals and expectations is central to our process.

Approach to Clinical Decision-Making

In addition to the heart team meetings, the team employs an algorithm for clinical decision-making, which has become more granular and includes the use of a scoring system. This decision-making guide has resulted in a greater standardization of care. Over the years, our rigorous multidisciplinary approach has benefited patients; the heart team has evaluated close to 1,000 patients. We have created a database that allows us to review recommendations and outcomes in this complex patient population.

Patient Referrals

Heart team evaluations are a significant source for referral of patients for Protected PCI and other higher-risk procedures such as chronic total occlusion PCI. Both inpatients and outpatients are referred to the heart team and include patients beyond those with coronary artery disease. To ensure all eligible patients in the community have the option of a Protected PCI, our Protected PCI coordinator is now initiating a community outreach program to build awareness of these potentially life-changing procedures.

SUMMARY

The heart team at Spectrum Health is singularly focused on providing the best available care to our patients. We are proud to meet the needs of the growing population of high-risk patients who may have been told that they have no other treatment options. We rely on the skills and expertise of the heart team and have a rigorous approach to achieve consensus on treatment decisions, while recognizing individual perspectives. This true team approach is positively impacting patient outcomes in our community, and we believe it is a model that other facilities can adopt with similar success.

David Wohns, MD, MBA, FACC, FSCAI
Division Chief of Cardiology
Spectrum Health Medical Group
Frederik Meijer Heart and Vascular Institute
Grand Rapids, Michigan
Disclosures: None.