The Future of Surgical Revascularization in Stable Ischemic Heart Disease

T Bruce Ferguson Jr; Cheng Chen


Future Cardiol. 2014;10(1):63-79. 

In This Article


Approaching SIHD from the physiologically augmented quantified functional anatomy approach suggested by Pepine and Douglas[74] and Marzilli et al.[73] creates knowledge complexities that exceed the resources of individual providers. A truly multidisciplinary Heart Team approach is necessary because it is the only logistic mechanism to assure that patient-centric decisions are made with a complete knowledge set.

In addition, the patient must be at the center of the delivery process, because the only way to organize and apply this knowledge is from a patient-centric and patient-specific perspective; every patient is at a different stage in this chronic disease process at each time of evaluation.

Across all of medicine, as described in detail in the Institute of Medicine report 'Best Care at Lower Cost: the Path to Continuously Learning Health Care In America', we, as providers, are becoming obligated to demonstrate value as defined by increasing quality at a lower cost.[79] Using the broadest definition for cardiovascular disease (CVD), our collective efforts on behalf of our patients consumes over 40% of Medicare spend, and according to this Institute of Medicine report, a third of this money is wasted. There are many examples of overuse, underuse and nonpatient-centric use of diagnoses and therapies of CVD. This progression from anatomy alone to a multicentric understanding of SIHD creates an opportunity to transition to a patient-centric, value-driven understanding and delivery of cardiovascular care.