The multidisciplinary team approach in cardiovascular care

This editorial refers to ‘Multidisciplinary teams to manage cardiovascular conditions’, by J.M. Hendriks. https://journals.sagepub.com/page/cnu/manage-cardiovascular-conditions. The general population is ageing and the prevalence of multimorbid cardiovascular conditions is rising. This has resulted in complex treatment approaches, not only focusing on the management of a particular condition but requiring a comprehensive approach, including treatment of the primary condition, underlying (cardiovascular) comorbidity and risk factors, and lifestyle modification. Novel models of care delivery have emerged in which multidisciplinary teams including nurses, allied professionals, medical professionals, as well as patients work closely together in collaborative practice models, aiming to improve patient outcomes. Since most of the care for chronic illnesses is performed by patients (and families) themselves, they should be engaged as a member of the multidisciplinary team. Practice guidelines of the European Society of Cardiology (ESC) have advocated multidisciplinary team approaches with specific roles for nurses and allied health professionals e.g. to improve professionals’ guideline adherence, support informed decision-making, and to provide patient-centred care.1,2 During the recent ESC Virtual Conference, the ESC guidelines for the management of atrial fibrillation (AF),3 acute coronary syndromes,4 and adult congenital heart disease5 were presented. These guidelines confirm the importance of multiple specialists’ collaboration with the patient, to manage these cardiovascular conditions by recommending a multidisciplinary team approach aiming to reduce morbidity and mortality whilst improving health-related quality of life. Probably the earliest multidisciplinary collaborative clinics in cardiology were established for management of patients with heart failure, in which heart failure nurse specialists, with specialized training have a crucial role.6 Providing person-centred care is important, given that this care would be respectful to the individual patient values, and as a result ensures these values guide clinical decisions.7 It is necessary to engage with patients to determine their needs, values and preferences, provide education and empower patients to perform self-care and being involved in shared decision-making.8 However, such processes require structured communication and care coordination, in which a nurse can take a leading position.9 As well as in acute, chronic and palliative care phases, the contribution of dedicated and specialized nurses is acknowledged.10 Multimorbidity can make treatment and self-care even more complex. For example, cardiac patients who suffered a stroke, often have multiple risk factors and specific interventions may be required in the rehabilitation and follow-up. Healthcare systems are often not integrated enough to provide such interventions and fragmentation of care may limit the patient in achieving desired outcomes.11 This has been recognized and the before mentioned guidelines recommend (Class I, level of evidence A) multidisciplinary exercise-based cardiac rehabilitation in these patients, to achieve a healthy lifestyle and manage risk factors in order to improve clinical outcomes and health-related quality of life.4 Alternative models of care, including tools such as telemedicine, telecare and telerehabilitation12 may be more suitable for cardiovascular patients. Although the COVID-19 pandemic has globally impacted the delivery of face to face care, it also brought opportunities. In-hospital consultations were often cancelled and many patients were relying on mHealth or eHealth interventions, to receive care and be in touch with their care providers.13,14 One example is the multidisciplinary TeleCheck-AF approach, which was rapidly implemented in clinical practice. This is a three-step approach in which an mHealth app-based intervention to measure heart rate and rhythm remotely, is used in combination with teleconsultation provided by cardiologists and AF-nurses, to maintain the provision of ongoing comprehensive AF care.15 Although multidisciplinary team approaches to manage patients with cardiovascular conditions require a redesign of practice, these approaches have potential to improve efficiency in care delivery resulting in improved clinical outcomes. A clear division of tasks and good communication is warranted to ensure prevention of fragmented care. Moreover, the team actively engaging and collaborating with the patient and their carers is crucial to achieve these outcomes. This may lead to a paradigm shift from single health care professionals deciding on the best treatment for the patient into an approach where a multidisciplinary team collaborates with the patient and treatment is based on an informed and shared decision. In short, a team approach is much more than the sum of its parts! Conflict of interest: none declared. The opinions expressed in this article are not necessarily those of the Editors of the European Journal of Cardiovascular Nursing or of the European Society of Cardiology.