How WhiteGloveMD reviews a cardiac surgery case.
The peer-reviewed evidence base, the validated risk calculators, and the dual-physician review process behind every White Glove Insights™ Report.
Every WhiteGloveMD case is scored against current ACC/AHA, AATS, and ESC guidelines, with three validated risk calculators (STS PROM, EuroSCORE II, AATS) computed for every case. The clinical recommendation is then read, refined, and signed by two licensed US physicians — a cardiothoracic surgeon and a consulting cardiologist. Discordant reads trigger third-physician adjudication. Surgeon and institution matching draws from STS Public Reporting, CMS Care Compare, NPPES, state medical board records, and US News. The full bibliography is at /clinical-bibliography.md.
Guidelines referenced.
2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease
Aortic stenosis, aortic regurgitation, mitral valve disease, tricuspid valve disease, prosthetic valve management, endocarditis. Plus the 2023 focused update.
2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization
CABG vs PCI decisions, multivessel disease, left main disease, diabetic patients, complete vs incomplete revascularization.
2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease
Ascending aortic aneurysm thresholds, aortic dissection management, root replacement timing, connective tissue disease (Marfan, Loeys-Dietz).
2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure
Heart failure pharmacotherapy (four pillars), LVAD candidacy, transplant candidacy, mitral repair for functional MR.
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation
Surgical MAZE indications, concomitant AF surgery, left atrial appendage exclusion, post-op AF management.
2024 AATS Expert Consensus on Aortic Surgery
Specialist-level aortic root and arch surgical strategy, valve-sparing vs Bentall, frozen elephant trunk.
2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease
Cross-validation against European guideline recommendations.
2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy
Surgical septal myectomy vs alcohol septal ablation; HCM-specific decisions.
2023 ESC Guidelines for the Management of Cardiovascular Disease in Patients with Diabetes
Diabetic-specific revascularization and risk modification.
Risk calculators.
STS PROM — Society of Thoracic Surgeons Predicted Risk of Mortality
The most widely used cardiac surgery risk score in North America. Calibrated against the STS National Database, which captures over 95% of US adult cardiac surgery cases. Approximately 40 patient variables. Validated reference: Shahian DM et al. Ann Thorac Surg. 2018;105(5):1411-1418.
EuroSCORE II
European logistic regression risk model. 18 clinical variables. Replaced the original EuroSCORE in 2012. Validated against 22,381 patients across 154 hospitals in 43 countries. Reference: Nashef SA et al. Eur J Cardiothorac Surg. 2012;41(4):734-744.
AATS Operative Risk Model
American Association for Thoracic Surgery. 75+ variables. Predicts eight outcomes: operative mortality, major morbidity, prolonged ventilation, deep sternal wound infection, stroke, reoperation for bleeding, renal failure, prolonged length of stay. Captures frailty inputs (5-meter walk, grip strength, Katz ADL, Clinical Frailty Scale) more thoroughly than STS or EuroSCORE.
WhiteGloveMD Composite Score
Proprietary aggregation of the three calculators above. Reduces single-model bias. Reported alongside the three component scores so the patient and treating physicians can see each model’s output directly. Discordances of greater than 50% between models trigger a sensitivity-analysis flag in the report.
Surgeon & institution matching data sources.
- STS Public Reporting OnlineStar ratings for isolated CABG, isolated AVR, AVR+CABG, isolated mitral, mitral+CABG. Updated quarterly. https://publicreporting.sts.org
- CMS Care CompareOverall hospital stars, risk-adjusted mortality, complication ratings, readmission rates. Continuously updated. https://www.medicare.gov/care-compare
- NPPES NPI RegistryPhysician identity, specialty, taxonomy code, practice address verification. Authoritative federal source.
- State medical board recordsActive licensure verification per state, disciplinary actions if any.
- US News & World Report Cardiovascular RankingsAnnual specialty rankings as a secondary, less-weighted input.
- Direct clinical inquiryWhen public data is insufficient, the WhiteGloveMD team contacts the institution directly to verify procedure-specific surgeon volume.
Peer-review process.
- Records ingestion. Every uploaded document is split, classified, and organized, and the data is normalized. Provenance is tracked per data point.
- Signal extraction. The primary cardiac pathology, urgency tier, and any contradictions in the chart are identified.
- Risk scoring. STS PROM, EuroSCORE II, and AATS are computed for every case, with sensitivity analysis on missing variables.
- Guideline mapping. The case is cross-referenced to the appropriate ACC/AHA, AATS, and ESC guideline class so the physicians can review every recommendation against the published evidence.
- Cardiothoracic surgeon review. The surgeon reads the records, the organized chart, and the risk profile. May confirm, modify, or override.
- Cardiologist review. A consulting cardiologist independently reads the case and reaches their own conclusion. The two physicians compare notes.
- Discordance adjudication. If the surgeon and cardiologist disagree on the central recommendation, a third Heart Team senior physician is brought in to adjudicate.
- Report assembly. The 13-section White Glove Insights™ Report is assembled.
- Plain-language translation. The physicians' clinical reasoning is translated into patient-facing language for the "Understanding Your Conditions" section.
- Dual signature. Both physicians digitally sign the report. NPI and academic affiliations are listed under the signature block.
- Quality assurance log. Every case retains a complete audit trail — the organized record set, physician notes, discordance log if any. Held for quality improvement and any future patient inquiry.
Frequently asked questions.
What clinical guidelines does WhiteGloveMD follow?
Every White Glove Insights™ Report is scored against the current ACC/AHA, AATS, and ESC guidelines for the relevant cardiac pathology: 2020 ACC/AHA Valvular Heart Disease guideline (and 2023 focused update); 2021 ACC/AHA/SCAI Coronary Artery Revascularization guideline; 2022 ACC/AHA Aortic Disease guideline; 2022 AHA/ACC/HFSA Heart Failure guideline; 2023 ACC/AHA Atrial Fibrillation guideline. The 2024 AATS Expert Consensus on Aortic Surgery and the 2021 ESC/EACTS Valvular Heart Disease guideline are also referenced when relevant.
What risk calculators does WhiteGloveMD use?
Three validated, peer-reviewed cardiac surgery risk calculators are computed for every report: (1) STS PROM (Society of Thoracic Surgeons Predicted Risk of Mortality), validated against the STS National Database covering 95%+ of US cardiac surgery programs; (2) EuroSCORE II, validated against 22,381 patients across 154 hospitals in 43 countries; (3) AATS Operative Risk Model, 75+ variables predicting eight perioperative outcomes including mortality, major morbidity, prolonged ventilation, deep sternal wound infection, stroke, reoperation for bleeding, renal failure, and prolonged length of stay. The three are aggregated into the WhiteGloveMD Composite Score.
How does WhiteGloveMD match patients to surgeons and hospitals?
Provider matching draws on five data sources: (1) STS Public Reporting — star ratings for isolated CABG, isolated AVR, AVR+CABG, isolated mitral, mitral+CABG; (2) CMS Care Compare — overall stars, mortality rating, complication rating; (3) NPPES NPI Registry — physician verification; (4) state medical board records — licensure verification; (5) US News & World Report cardiovascular rankings. Matching considers procedure-specific surgeon volume, institution annual volume, patient geographic accessibility, and any patient-specific anatomic or comorbid factors that warrant a sub-specialized center.
How does the WhiteGloveMD review process work?
The process moves in a fixed sequence. First, every uploaded record is organized, classified, and provenance-tracked. Then the case is scored with three validated risk models (STS PROM, EuroSCORE II, AATS) and mapped to the relevant ACC/AHA, AATS, and ESC guideline class. A cardiothoracic surgeon and a consulting cardiologist each independently read the records and the risk profile, reach their own conclusions, and compare notes. The report is then assembled, the clinical reasoning is translated into plain language for the patient, and surgeon-and-institution matching is added. Both physicians sign before delivery — every clinical decision is made by the physicians.
Who makes the clinical decisions on my case?
Your physicians. Every recommendation in every report is reviewed and signed by both a cardiothoracic surgeon and a consulting cardiologist. Structured tools help organize the chart and compute the validated risk scores, but they do not make recommendations — the two physicians read the case, weigh the evidence, and make the call.
What is the WhiteGloveMD peer-review process?
Every report is read by two physicians before delivery: a cardiothoracic surgeon and a consulting cardiologist. Discordant reads — when the two physicians disagree on the central recommendation — trigger a third-physician adjudication by a Heart Team senior member. The peer-review log for each case is retained for quality assurance.
For the complete peer-reviewed evidence base, see the WhiteGloveMD Clinical Bibliography — 40+ peer-reviewed cardiac surgery sources.
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