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• W4377101271 abstract "It can be estimated that the human heart will contract more than 2.5 billion times in a lifespan of 70 years. Blood is propelled into the aorta more than 2.5 million times in a lifetime as the initial conduit to systemic tissue perfusion. It is difficult to overstate the importance of a healthy aorta; when aortic disease manifests itself, its management can be challenging, with a high risk for potential morbidity and mortality when intervention is required. To this end, the American College of Cardiology (ACC) and the American Heart Association (AHA) sponsored an expert panel of authors to create a guideline document that offers recommendations for diagnosing and managing a wide spectrum of aortic diseases. This ACC/AHA report was published in December of 2022.1Isselbacher EM Preventza O Black J 3rd Hamilton et al.2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology joint committee on clinical practice guidelines.Circulation. 2022; 146: e334-e482Crossref PubMed Scopus (120) Google Scholar Although an expansive range of topics and presentations related to aortic diseases are covered in the 111-page manuscript, these updated Guidelines (which replace a 2010 document) now explicitly highlight the benefits that are conferred when a team-based approach is used in caring for patients with aortic diseases; specific mentions are made regarding the importance of the use of the Multidisciplinary Aortic Team (MAT) and aortic disease care provision at a high-volume aortic treatment center.2Hiratzka LF Bakris GL Beckman JA et al.ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine [published correction appears in J Am Coll Cardiol 2013 Sep 10;62:1039-40].J Am Coll Cardiol. 2010; 55: e27-129Crossref PubMed Scopus (1144) Google Scholar This acknowledgement of the importance of multidisciplinary teams at those centers caring for patients with aortic diseases within the aforementioned Guideline is consistent with much of the published data from multiple other cardiac interventions, including transcatheter aortic valve replacement, mitral valve interventions, heart failure, and cardiogenic shock, in which improvements in patient outcomes and safety have been noted.3CM Otto Nishimura RA et al.Writing Committee Members2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.J Thorac Cardiovasc Surg. 2021; 162: e183-e353Abstract Full Text Full Text PDF PubMed Google Scholar, 4Heidenreich PA Bozkurt B Aguilar D et al.2022 AHA/ACC/HFSA Guideline for the management of heart failure: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.J Am Coll Cardiol. 2022; 79: 1757-1780Crossref PubMed Scopus (174) Google Scholar, 5Papolos AI Kenigsberg BB Berg DD et al.Management and outcomes of cardiogenic shock in cardiac ICUs with versus without shock teams.J Am Coll Cardiol. 2021; 78: 1309-1317Crossref PubMed Scopus (54) Google Scholar The writing committee that was convened to create the Aortic Disease Guidelines reflected a multidisciplinary cohort, represented by cardiac surgeons, cardiologists, vascular surgeons, a geneticist, a radiologist, a cardiovascular anesthesiologist, and an emergency medicine physician.1Isselbacher EM Preventza O Black J 3rd Hamilton et al.2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology joint committee on clinical practice guidelines.Circulation. 2022; 146: e334-e482Crossref PubMed Scopus (120) Google Scholar The ACC and AHA are to be commended for explicitly stating the importance of multidisciplinary teams in these Guidelines; an argument may be made that a firm statement is overdue. The “team approach” to address the management of complex clinical issues has a large potential upside of desirable benefits, including broadening of patient-focused considerations and identification (and reduction) of errors in patient evaluation and management. A team is a “group of people who perform interdependent tasks to work toward accomplishing a common mission or specific objective.”6What is a Team? Available at: https://asq.org/quality-resources/teams. Accessed May 8, 2023.Google Scholar Moreover, a healthcare team should be “professionals from various disciplines who enter a collaborative relationship with the patient to deliver coordinated, high-value, and patient-centered healthcare.”7Martin AK Green TL McCarthy AL Sowa PM Laakso EL. Healthcare teams: Terminology, confusion, and ramifications.J Multidiscip Healthc. 2022; 15: 765-772Crossref PubMed Scopus (1) Google Scholar In advanced clinical practice teams, such as those associated with high-risk conditions like aortic diseases, these definitions may be melded and refocused; such a team should be a multidisciplinary group of professionals who use their respective backgrounds, education, experiences, and expertise to offer opinion, insight, perspective, and nuance toward a unified management goal. From this perspective, MAT should be created in centers that treat aortic diseases. While an in-depth commentary on the overall quality of healthcare provided to patients with aortic diseases is beyond the scope of this manuscript, patients and physicians alike want the best possible experience and outcomes. To this end, it is acknowledged that “old habits die hard.” Historically, patient care could be disparate—the diagnosis and offered treatment of a particular condition might have been left entirely to the discretion of the physician who saw the patient initially or to whichever specialist received a referral or consultation request. This, of course, left the evaluation and management of patients open to a greater tendency for error. Error is acknowledged to be a significant contributor to suboptimal patient outcomes, and, unfortunately, all physicians are at risk of committing 1 (or more) type of well-described sources of error.8Makary MA Daniel M. Medical error-the third leading cause of death in the US.BMJ. 2016; 353: i2139Crossref PubMed Google Scholar Attribution error, anchoring error, and availability error occur, which are caused by the bias that exists when only 1 perspective is applied. Attribution error describes a mistake made due to an association of a patient's condition with stereotypes or prior experiences. Anchoring error occurs when a single symptom, sign, or fact in a clinical scenario is inappropriately considered, wrongly influencing further decision-making. Availability error is the tendency to apply what is familiar or commonly seen to clinical situations instead of considering novel diagnoses or approaches to care.9McGrath BM. How doctors think.Can Fam Physician. 2009; 55: 1113Google Scholar It must be underscored that these errors are mistakes that can occur even when physicians are applying their undivided attention to the patients and issues at hand; the risk of considerable error is even greater when we account for the seemingly unending interruptions, alerts, and mandates that compete for our time while trying to care for patients.10Grissinger M. Sidetracks on the safety express: Interruptions lead to errors and … wait, what was I doing?.P T. 2015; 40: 145-190PubMed Google Scholar Multidisciplinary teams can serve as a means of support, redirection, and focus when the aforementioned opportunities for error arise. Unfortunately, there is a dearth of literature that “proves” that the multidisciplinary team improves outcomes; much of the literature is observational, but some compelling support exists.11Batchelor W Anwaruddin S Wang D et al.The multidisciplinary heart team in cardiovascular medicine.JACC Adv. 2023; 2 (Accessed May 8, 2023): 100160https://doi.org/10.1016/j.jacadv.2022.100160Crossref Google Scholar In a simulated environment, it has been shown that clinical errors among healthcare teams decrease as scores on a validated measure of teamwork increase.12Herzberg S Hansen M Schoonover A et al.Association between measured teamwork and medical errors: An observational study of prehospital care in the USA.BMJ Open. 2019; 9e025314Crossref PubMed Scopus (28) Google Scholar In 1997, a post hoc analysis of the registry of the Emory Angioplasty versus Surgery Trial, which compared outcomes between angioplasty and coronary bypass surgery for treatment of coronary artery disease, found that patients who had a revascularization strategy created by a multidisciplinary team had better survival than those simply randomized into one cohort or the other.13King SB Barnhart HX Kosinski AS et al.Angioplasty or surgery for multivessel coronary artery disease: Comparison of eligible registry and randomized patients in the EAST trial and influence of treatment selection on outcomes. Emory Angioplasty versus Surgery Trial investigators.Am J Cardiol. 1997; 79: 1453-1459Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar More recently, a retrospective study of an Australian transcatheter aortic valve replacement registry showed a robust reduction in 5-year risk-adjusted mortality after implementing a multidisciplinary heart team in transcatheter aortic valve replacement care.14Jones DR Chew DP Horsfall MJ et al.Multidisciplinary transcatheter aortic valve replacement heart team programme improves mortality in aortic stenosis.Open Heart. 2019; 6: e00098Crossref Scopus (16) Google Scholar Aortic diseases often represent a complex clinical entity in which a multifaceted, team approach to evaluation and management is now formally sponsored by updated ACC/AHA guidelines in the form of an MAT. Anesthesiologists are key stakeholders in these teams, given their role in perioperative teams spanning the preoperative, intraoperative, and postoperative continuum. As historic leaders of perioperative safety and focused team participation (eg, “Code Blue” response teams, Difficult Airway Teams), we have yet another opportunity to step into MAT to provide meaningful support to those impacted by and caring for persons with aortic diseases.15Price JW Applegarth O Vu M Price JR. Code blue emergencies: A team task analysis and educational initiative.Can Med Educ J. 2012; 3: e4-20Crossref PubMed Google Scholar,16Mark LJ Herzer KR Cover R et al.Difficult airway response team: A novel quality improvement program for managing hospital-wide airway emergencies.Anesth Analg. 2015; 121: 127-139Crossref PubMed Scopus (76) Google Scholar" @default.
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• W4377101271 title "Multidisciplinary Teams: Better Together" @default.
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