{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T22:52:45Z","timestamp":1783464765204,"version":"3.55.0"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,7,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The multidisciplinary Heart Team (HT) is recommended for management decisions for transcatheter aortic valve replacement (TAVR) candidates, and during TAVR procedures. Empiric evidence to support these recommendations is limited. We aimed to explore temporal trends, drivers, and outcomes associated with HT utilization.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">TAVR candidates were identified in Ontario, Canada, from April 1, 2012 to March 31, 2019. The HT was defined as having a billing code for both a cardiologist and cardiac surgeon during the referral period. The procedural team was defined as a billing code during the TAVR procedure. Hierarchical logistical models were used to determine the drivers of HT. Median odds ratios were calculated to quantify the degree of variation among hospitals. Of 10\u00a0412 patients referred for TAVR consideration, 5489 (52.7%) patients underwent a HT during the referral period, with substantial range between hospitals (median odds ratio of 1.78). Utilization of a HT for TAVR referrals declined from 69.9% to 41.1% over the years of the study. Patient characteristics such as older age, frailty and dementia, and hospital characteristics including TAVR program size, were found associated with lower HT utilization. In TAVR procedures, the procedural team included both cardiologists and cardiac surgeons in 94.9% of cases, with minimal variation over time or between hospitals.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">There has been substantial decline in HT utilization for TAVR candidates over time. In addition, maturity of TAVR programs was associated with lower HT utilization.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.020741","type":"journal-article","created":{"date-parts":[[2021,6,22]],"date-time":"2021-06-22T09:21:45Z","timestamp":1624353705000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Temporal Trends and Drivers of Heart Team Utilization in Transcatheter Aortic Valve Replacement: A Population\u2010Based Study in Ontario, Canada"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5719-7225","authenticated-orcid":false,"given":"Gil","family":"Marcus","sequence":"first","affiliation":[{"name":"Schulich Heart Program Division of Cardiology Sunnybrook Health Sciences Centre University of Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Qiu","sequence":"additional","affiliation":[{"name":"ICES Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ragavie","family":"Manoragavan","sequence":"additional","affiliation":[{"name":"Schulich Heart Program Division of Cardiology Sunnybrook Health Sciences Centre University of Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6840-8051","authenticated-orcid":false,"given":"Dennis T.","family":"Ko","sequence":"additional","affiliation":[{"name":"Schulich Heart Program Division of Cardiology Sunnybrook Health Sciences Centre University of Toronto Ontario Canada"},{"name":"ICES Toronto Ontario Canada"},{"name":"Institute for Health Policy Management and Evaluation University of Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1922-9174","authenticated-orcid":false,"given":"Gabby","family":"Elbaz\u2010Greener","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hadassah Medical Center Jerusalem Israel"},{"name":"Faculty of Medicine Hebrew University of Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4079-2618","authenticated-orcid":false,"given":"Jennifer C. Y.","family":"Chung","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery Department of Surgery Peter Munk Cardiac Centre University Health NetworkUniversity of Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maneesh","family":"Sud","sequence":"additional","affiliation":[{"name":"Schulich Heart Program Division of Cardiology Sunnybrook Health Sciences Centre University of Toronto Ontario Canada"},{"name":"ICES Toronto Ontario Canada"},{"name":"Institute for Health Policy Management and Evaluation University of Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Farkouh","sequence":"additional","affiliation":[{"name":"Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre University of Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina","family":"Madan","sequence":"additional","affiliation":[{"name":"Schulich Heart Program Division of Cardiology Sunnybrook Health Sciences Centre University of Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1723-3049","authenticated-orcid":false,"given":"Stephen E.","family":"Fremes","sequence":"additional","affiliation":[{"name":"Schulich Heart Program Division of Cardiac Surgery Sunnybrook Health Sciences Centre University of Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8464-1080","authenticated-orcid":false,"given":"Harindra C.","family":"Wijeysundera","sequence":"additional","affiliation":[{"name":"Schulich Heart Program Division of Cardiology Sunnybrook Health Sciences Centre University of Toronto Ontario Canada"},{"name":"ICES Toronto Ontario Canada"},{"name":"Institute for Health Policy Management and Evaluation University of Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.5603\/KP.2018.0013"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000503"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2015.11.008"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2019.08.011"},{"key":"e_1_3_2_6_2","unstructured":"CoreHealth Ontario . 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