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The patient is back at the center of attention and should be the priority in medical decision-making. This is the recommendation of the recent guidelines on coronary revascularization from the ESC/EACTS (European Society of Cardiology/European Association for Cardio-Thoracic Surgery) and the ACC/AHA (American College of Cardiology/American Heart Association).1-3 Through compilation and synthesis of the best scientific evidence for decision-making relating to patients with coronary artery disease, these guidelines reinforce and specifically recommend adoption of a multidisciplinary approach in clinical decision-making, involving discussion between cardiologists, interventional cardiologists and the cardiac surgeons, in order to provide the best patient-oriented care. The decision-making process and provision of medical information to patients should be guided by the approach known as the “four principles” for health ethics: autonomy, beneficence, non-maleficence and fairness.1 Establishment of a multidisciplinary team has the aim of enabling balanced clinical decision-making through evidence-based protocols that are designed in collaboration between cardiologists, interventional cardiologists and cardiac surgeons. The cases of all patients with stable coronary artery disease must be discussed by a multidisciplinary heart team before making decisions on the type of revascularization procedure to be indicated or deciding to keep the patients on medication treatment only. With the mounting complexity of cases and severity of patients’ conditions, there is often a need to involve other experts, depending on the comorbidities that are observed, such as diabetes specialists, general practitioners, nephrologists, intensivists, referral physicians or anesthesiologists, such that their combined experience and expertise can decisively contribute towards the most appropriate decision. Therefore, it is essential for the heart team to review each patient’s case before issuing a treatment recommendation relating to that patient’s heart condition. Hospitals and healthcare institutions are encouraged to establish multidisciplinary teams so that procedures can be guided towards what is most appropriate and necessary for patients. One study in the United States has suggested that 50% of patients may not have received adequate treatment, in the way proposed through guidelines.4 Consequently, the Centers for Medicare and Medicaid Services (CMS) is implementing a program in which Medicare auditors will review all medical records and assess the adequacy of the procedures and devices used and the procedure applications or hospital admissions made, prior to paying those bills. The new program went into effect in January 2012.5 Correct indications for procedures not only result in benefits for patients but also result in reduced costs for public and private payers, which can serve to redirect resources to areas that are most in need. It has been suggested that standard institutional protocols compatible with the current guidelines can be used to avoid the need for systematic case-by-case review of all IMD, PhD. Associate Professor of Cardiovascular Surgery, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil. IIMD, PhD. Emeritus Professor and Pro-Rector of Faculdade de Medicina de Sao Jose do Rio Preto (Famerp); Full Professor at Universidade Estadual de Campinas (Unicamp), Campinas, Sao Paulo, Brazil.

The concept of heart team in cardiac diseases: the patient is back as a priority in medical decisions