The idea of the heart team is a noble one: physicians with different skillsets and specialties evaluate a patient together and, in perfect harmony, make a joint treatment decision to ensure good outcomes for a patient. Heart teams were used in the past for revascularization, and are currently being used for heart valve treatments, ventricular assist device surgeries, and other cutting-edge procedures with complex decision criteria.

In fact, discussions on how to manage effective heart teams has been a hot conference topic within the US cardiovascular conference circuit this year, especially with the growing interest of using TAVR in lower surgical risk patients.

So why are heart teams gaining popularity in the US TAVR landscape.  First and foremost, reimbursement from CMS depends on patients being evaluated by a multidisciplinary team that includes a cardiac surgeon and an interventional cardiologist at the very least, and up to seven additional specialties including heart failure specialists, nurse practitioners, social workers, and more. Second, the decision to treat a patient with any heart disease, and especially aortic valve disease or chronic heart failure; is complex due to the high cost of treatment, the relative frailty of the patients being treated, and the arduous nature of the recovery process. Gaining perspective from a social worker, who is able to evaluate the patient's support network and assess how their recovery will progress, is just as valuable as input from a heart failure specialist with a clinical focus.

But the European experience shows that multidisciplinary heart teams may be a passing fad. When TAVR was first introduced there, heart teams were a necessity. In fact, many guidelines still recommend using a heart team. Despite this, physicians that I've talked to about the heart team concept in Europe seem to feel that it is not long for this world. In many cases, a performing physician will bypass the heart team and make an individual call on the treatment decision. In other cases, the heart team is just a formality and a single physician exerts ultimate control over the group's decisions. One physician I spoke to in particular stated that the idea of a heart team was simply to spare the feelings of cardiac surgeons and make them feel involved in the treatment decision, while another physician stated that the increased cost associated with up to 8 specialties deliberating over a single patient was seen as unnecessary in his institution.

The difference seems to be twofold: first, European physicians are more comfortable and familiar with TAVR and therefore are more comfortable making decisions on an individual basis; and second, reimbursement in the US seems to depend more on the heart team concept than in Europe. Until US payors decide that the increased cost of deliberation outweighs the improvement in patient outcomes, the heart team will live on.

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