At an academic center like Froedtert & the Medical College of Wisconsin Froedtert Hospital, complex heart patients are more the rule than the exception. To give them the advanced care they require, as well as to collaborate with community physicians, Froedtert & MCW specialists have developed a multidisciplinary approach centered on case conferences.
Paul Pearson, MD, PhD, cardiothoracic surgeon and MCW faculty member, defined the characteristics that make heart patients complex.
“One category is patients with a simple cardiac problem but other medical complications, for example, coronary artery blockages with some level of kidney failure, lung failure or other conditions,” he said. “The other category is patients with a complex heart problem like valve disease, who have had previous surgery or intervention and now need additional therapies.”
Previously, patients like these might have relied completely on the treatment recommendations of a single provider or, conversely, sought recommendations from multiple specialists not working together, and then attempted to make a decision on their own.
The Experience of Many for One
“We offer a group of physicians with different areas of expertise in treating the same problem, who work together to review these complex cases and come to a consensus about the best therapy,” Dr. Pearson said. “The patient benefits because the experience of these experts is leveraged to treat their individual condition.”
The team includes specialists from many disciplines, including cardiothoracic surgery, general cardiology, interventional cardiology, echocardiography, heart failure cardiology and electrophysiology. They meet weekly to discuss complex cases and recommend a course of treatment. They can also meet virtually when patients come in on an emergency basis and can’t wait for the weekly case conference.
When necessary, the team will bring in specialists from other areas, such as pulmonology if a patient has severe lung disease, or liver and kidney disease if the patient has had a transplant.
“We have many tools to help us tailor treatment to each patient,” Dr. Pearson said.
Combining Skills to Innovate
The close working relationship of specialists at Froedtert Hospital often leads to their combining skills to perform an innovative, hybrid procedure. Dr. Pearson cited the example of a patient who previously had surgery to replace the ascending aorta, but the suture line had broken and blood was escaping outside the graft.
“Interventional cardiologists could plug the leak but couldn’t get to the spot,” Dr. Pearson said. “Surgeons, however, were able to make a small incision in the chest and deliver a plastic tube into the beating heart for interventional cardiologists to place the plug. By working together, they were able to do that in a minimally invasive way, and the patient went home in a day instead of facing a big heart operation.”
Supporting Physicians on the Front Lines
Many heart patients come to the Froedtert & MCW health network via referral from other physicians. If patients live far from Froedtert Hospital, physicians can submit their data for review by the team without the patient having to come in.
“The referring physician can call in to the conference and discuss the patient, whether to reaffirm a treatment decision or to consider other treatment options,” Dr. Pearson said. “In these cases, we help them with their decision-making rather than being actively involved in patient care.”
When referral patients do come to Froedtert Hospital, our team coordinates care with the patient’s physician.
“We keep the referring physician in the loop about treatment and return the patient to them,” Dr. Pearson said. "Typically, heart patients need long-term relationships with their cardiologists, and we support that.”
The Froedtert & MCW cardiac team understands that community physicians are practicing on the front lines, and if they’re with smaller systems, they may not have deep support in their specialty.
“We provide them with a state-of-the-art second opinion for their patients,” Dr. Pearson said. “The therapy we recommend will be dependent on what we think is best. Just because a patient comes to a surgeon at Froedtert Hospital doesn’t mean they’ll automatically get an operation. They might get an interventional procedure if we think that’s best. We make recommendations for treatment based on consensus.”
For Our Referring Physicians:
Academic Advantage of a Multidisciplinary Team
The Froedtert & MCW health network gives patients and their referring physicians a distinct advantage.
Contact our physician liaison team for more information about cardiac case conferences or if you would be interested in meeting with any of the multidisciplinary heart & vascular team members.