B-21 | The Heart Team Approach to Cardiovascular Care at Miami Cardiac and Vascular Institute: Baptist Health South Florida

The Heart Team (HT) approach to patients with complex cardiovascular disease carries a Class I indication in several cardiovascular societal guidelines. We describe the feasibility and successful implementation of the HT approach to care at Miami Cardiac and Vascular Institute (MCVI), Baptist Health South Florida. HT meetings were organized once and on an as needed basis twice weekly. With coordination by a surgical APRN, meeting information and cases to be discussed were shared via a HIPAA compliant platform. Cases were presented by the involved cardiologist or surgeon, imaging and other data reviewed and HT decisions were documented using a standardized form in the patient's electronic medical record. We collected patient demographic data, safety outcomes and major adverse cardiovascular and cerebrovascular events in addition to specialties represented at the meetings, treatment strategy and final treatment delivered. From June 18, 2020 to July 31, 2022 a total of 171 patients were evaluated by the HT at MCVI. HT meetings were attended by a general cardiologist 90 times (53%), Interventional cardiologist 167 times (98%), cardiac surgeon 168 times (98%), cardiac imaging specialist 64 times (37%) and advanced heart failure specialist 146 times (85%). Of the 171 patients, 37 (22%) underwent PCI, 37 (22%) underwent CABG, 47 (27%) underwent medical management and for 30 (17%) further workup was advised or a decision was deferred. The inpatient mortality rate was 2% for patients who underwent surgical revascularization. The STS CABG mortality for 2019 (the year before HT implementation) was 2.3%. Other major adverse cardiovascular events included myocardial infarction (3%), reoperation for failure of surgical repair (0.6%), stroke (1%), renal failure (3%), deep wound infection (2%) and sepsis (2%). We demonstrated that the development of a HT is feasible and if properly implemented can have reliable attendance by multiple specialties. Best practices include at least weekly meetings, a HIPAA compliant messaging platform and standardized documentation of HT decisions in the patient record. Our data suggests improved outcomes but more follow up is warranted.