New guidelines for patients with coronary artery disease emphasize the role of a multidisciplinary heart team, an approach that has been practiced for more than a decade at Columbia University Irving Medical Center.
The guidelines recommend the heart team approach for patients with blockages in the coronary arteries who are being considered for revascularization procedures-via surgery or insertion of stents-but for whom the optimal treatment strategy is unclear.
With a heart team approach, when a patient with complex heart artery blockages is seen, the case is discussed collaboratively among several specialists, including surgeons and interventional cardiologists, to create the best treatment plan in a patient-centered way.
Columbia heart surgeon Paul Kurlansky, MD, co-authored the guidelines, which were issued jointly by the American College of Cardiology, the American Heart Association, and the Society for Cardiovascular Angiography & Interventions. Kurlansky is associate professor of surgery at Columbia University Vagelos College of Physicians and Surgeons and associate director of the Center for Innovation and Outcomes Research in Columbia's Department of Surgery.
"It's often the case that if the patient sees a surgeon, the patient gets surgery; if a patient sees an interventional cardiologist, the patient gets stents; and if the patient sees a medical cardiologist, the patient gets medication. That may not be the best option for the patient."
"It's important for patients to understand that the heart team approach is something that is professionally endorsed," says Kurlansky, "and there is a movement among the physicians and surgeons who treat these patients to collaborate more often to provide the best care possible to each individual."
Kurlansky says that over the past decade, it has become increasingly clear that the heart team approach is the most optimal way to care for patients.
"It's often the case that if the patient sees a surgeon, the patient gets surgery; if a patient sees an interventional cardiologist, the patient gets stents; and if the patient sees a medical cardiologist, the patient gets medication," Kurlansky says. "That may not be the best option for the patient."
Not all patients with blockages need a heart team approach, but "at Columbia, in any situation where it's reasonable to expect there might be value in different approaches, those alternative approaches are discussed with other experts."
The heart team approach first evolved at Columbia 15 years ago when Columbia surgeons and interventional cardiologists collaborated to lead the first clinical trials that compared open heart surgery to a minimally invasive technique to repair a diseased heart valve.
"That close collaboration led to a change in perspective," Kurlansky says. "Rather than thinking that problem X is a medical problem and problem Y is a surgical problem, we now think 'the patient has a problem; there are various things we can do, and what is best for this patient?'"
Even the training at Columbia has evolved to reflect the patient-centric approach. Columbia was one of the first to offer a cardiothoracic surgery integrated training program, which includes training in medical cardiology and interventional cardiology. Surgeons trained through integrated programs are able to offer more options to patients.
For patients who have multiple options, Kurlansky recommends selecting a center that has experienced practitioners in many areas and who collaborate with each other.
"When you have excellent surgeons, excellent cardiologists, and excellent interventionalists, you get excellent outcomes," Kurlansky says.
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