Post on 06-Apr-2016
Österr.Kardiol.Gesellschaft 1990 Österr.Kardiol.Gesellschaft 1990 Arbeitsgruppe Intervent. KardiologieArbeitsgruppe Intervent. Kardiologie
H. MlczochH. Mlczoch W.Klein(+)W.Klein(+) P.ProbstP.Probst F.LeischF.Leisch V.MühlbergerV.Mühlberger
Monitor (Auditor) Report:
European Society of CardiologyEuropean Society of Cardiology http://www.insel.ch/kardiologie/downloadshttp://www.insel.ch/kardiologie/downloads
AUSTRIA 1990 -2004AUSTRIA 1990 -2004
BERNBERNESCESC
Volker Mühlberger, QualityVolker Mühlberger, Quality
AUSTRIAN ANGIOGRAPHY AUSTRIAN ANGIOGRAPHY +/- PCI- CENTERS 2003 +/- PCI- CENTERS 2003
4 Pediatric 4 Pediatric 31 Adult 31 Adult ((7 7 in Vienna)in Vienna)
Rooms (n=42)Rooms (n=42) (40 PTCA, 2 CAG)(40 PTCA, 2 CAG) http://gin.uibk.ac.at./iik/http://gin.uibk.ac.at./iik/ Bad Ischl is going to close 2004Bad Ischl is going to close 2004
26% der 103 Parameter wurden von 26% der 103 Parameter wurden von allen 31 Zentren rückgemeldet 2003allen 31 Zentren rückgemeldet 2003
0
10
20
30
40
50
60
70
80
90
100
% rückgemeldete Parameter
% d
er H
erzk
athe
ter-
Zent
ren
AUSTRIA 2002/2003AUSTRIA 2002/2003
� Angiography 41.051 43.644Angiography 41.051 43.644� PTCA=PCI 13.581 15.056PTCA=PCI 13.581 15.056� stentstent 84% 84% 87%87%� OP-CAD OP-CAD 4.147 4.147 4.020 4.020� OP- valve 1.892OP- valve 1.892 1.988 1.988
Volker Mühlberger, QualityVolker Mühlberger, Quality
Coronary Angiography Frequency Coronary Angiography Frequency per One Million Inhabitants per One Million Inhabitants
0
2000
4000
6000
8000
1992
1994
1996
1998
2000
2002
AU 8.12
CH 7.18
D 82.16
PCI Frequency per One Million PCI Frequency per One Million Inhabitants (AU/CH/D)Inhabitants (AU/CH/D)
0
500
1000
1500
2000
2500
3000
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
AUCHD
Gesamt-PCI und CA , n= 31 Zentren Österreich 2003; aufsteigend geordnet
0
500
1000
1500
2000
2500
3000
3500
4000
4500
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Zentrums-Nummern 1-29 geordnet nach Größenverhältnis PCI/CA aufsteigend
Anz
ahl
CA 2003 Gesamt PCI 2003
Prozentanteil von PCI zu CA der Jahre Prozentanteil von PCI zu CA der Jahre 2001 bis 2003 geordnet nach 2003 (n=29)2001 bis 2003 geordnet nach 2003 (n=29)
0
10
20
30
40
50
60
70
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Zentrums-Nummern geordnet nach Größenverhältnis PCI/CA aufsteigend
Proz
entw
ert
PCI/C
A (
%)
PCI/CA 2001
PCI/CA 2002
PCI/CA 2003
Volker Mühlberger, QualityVolker Mühlberger, Quality
%-PCI during Diagnostic %-PCI during Diagnostic Angio in Austria/SwitzerlandAngio in Austria/Switzerland
0
10
20
30
40
50
60
70
80
90
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
AU
CH
Volker Mühlberger, QualityVolker Mühlberger, Quality
Ratio of (CABG-OP+PCI) per Ratio of (CABG-OP+PCI) per Angiography in AU CH DAngiography in AU CH D
41
4840
50
39
51
39
4840
51
4047
42,844,9
43,744,9
0
10
20
30
40
50
6019
92
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
AU
CH
D
Volker Mühlberger, QualityVolker Mühlberger, Quality
PCI Hospital-Mortality (%) in PCI Hospital-Mortality (%) in Austria, Switzerland and GermanyAustria, Switzerland and Germany
0,27
0
0,2
0,4
0,6
0,8
119
92
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
AU
CH
D
Volker Mühlberger, QualityVolker Mühlberger, Quality
Elective and Overall - Elective and Overall - PCI Hospital-PCI Hospital-Mortality (%) in AustriaMortality (%) in Austria
00,10,20,30,40,50,60,70,80,9
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Overall
Elective
Volker Mühlberger, QualityVolker Mühlberger, Quality
Ratio of STENTING per PCI Ratio of STENTING per PCI (%) in AU/CH/D(%) in AU/CH/D
76 79 81
0102030405060708090
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
AU
CH
D
Volker Mühlberger, QualityVolker Mühlberger, Quality
Ratio of emergency CABG due to Ratio of emergency CABG due to PCI (%) in Austria/SwitzerlandPCI (%) in Austria/Switzerland
0
0,2
0,4
0,6
0,8
1
1,2
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
AU
CH
Volker Mühlberger, QualityVolker Mühlberger, Quality
EMERGENCY CABG AFTEREMERGENCY CABG AFTER PCI (%)-MORTALITY in AustriaPCI (%)-MORTALITY in Austria
3,38,3
18,2
28,6
8,3
15,4 16
25
32
12 10,5
0
5
10
15
20
25
30
35
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Volker Mühlberger, QualityVolker Mühlberger, Quality
Infarction as Complication (%) after Infarction as Complication (%) after PCI in Austria and SwitzerlandPCI in Austria and Switzerland
0,85
00,20,40,60,8
11,21,41,61,8
219
92
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
AU
CH
D
PCI for acute Myocardial Infarction PCI for acute Myocardial Infarction (% of total) in Austria and Switzerland(% of total) in Austria and Switzerland
0
2
4
6
8
10
12
14
1619
92
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
AU
CH
PCI for acute myocardial PCI for acute myocardial infarction (n) in Austriainfarction (n) in Austria
0
200
400
600
800
1000
1200
1400
1600
1800
1998 1999 2000 2001 2002 2003
PCI MIwith shock
PCI MIwithoutshock
Volker Mühlberger, QualityVolker Mühlberger, Quality
PCI FOR =PCI FOR = DURING ACUTE DURING ACUTE MIMI (%)-MORTALITY in Austria(%)-MORTALITY in Austria
27
2,5
31
2,8
35
2,6
30
2,1
17
2
17,2
2,2
0
5
10
15
20
25
30
35
1998 1999 2000 2001 2002 2003
PCI forMI+Shock
PCI for MIwithoutShock
Volker Mühlberger, QualityVolker Mühlberger, Quality
% GP IIb/IIIa for PCI% GP IIb/IIIa for PCI
0
5
10
15
20
25
1996 1997 1998 1999 2000 2001 2002 2003
AU
CH
DRUG ELUTING STENTS (DES) DRUG ELUTING STENTS (DES) in Austria (n)in Austria (n)
0
200
400
600
800
1000
1200
1400
1600
2002 2003
Sirolimus
Tacrolimus
Paclitaxel
DRUG ELUTING STENTSDRUG ELUTING STENTS (DES) in Austria (% of stents) (DES) in Austria (% of stents)
0
5
10
15
20
25
2001 2002 2003
DES
Volker Mühlberger, QualityVolker Mühlberger, Quality
Puncture site closing devices Puncture site closing devices (% of PCI)(% of PCI)
1923
39,3
0
5
10
15
20
25
30
35
40
45
50
1998 1999 2000 2001 2002 2003
AU
CH
Volker Mühlberger, QualityVolker Mühlberger, Quality
Brachial Brachial and Radial Approach %and Radial Approach %
0
0,5
1
1,5
2
2,5
3
3,5
1999 2000 2001 2002 2003
AUCH
Volker Mühlberger, QualityVolker Mühlberger, Quality
NEW DEVICES, AustriaNEW DEVICES, Austria
1992
1994
1996
1998
2000
2002
LASERROTABLIIb/IIIa
02000400060008000
100001200014000 LASER
DCA
ROTABL
IVUS
IIb/IIIa
STENT
Volker Mühlberger, QualityVolker Mühlberger, Quality
INNOVATIONENINNOVATIONEN Austria 2002/2003Austria 2002/2003
Brachytherapie 163/101Brachytherapie 163/101 Ultraschalltherapie 1/-Ultraschalltherapie 1/- Gerinnselentferner 148/173Gerinnselentferner 148/173 Transmyokardialer Laser 16/0Transmyokardialer Laser 16/0 Spinal Cord Stimulation 4/-Spinal Cord Stimulation 4/- Alkoholablation 4/4Alkoholablation 4/4 Defektverschlüsse 162/243Defektverschlüsse 162/243 Drug - Eluting - Stents 620/2938Drug - Eluting - Stents 620/2938
INNOVATIONEN II INNOVATIONEN II Austria 2003 Austria 2003
Stammzelltherapie mit Katheter 21Stammzelltherapie mit Katheter 21 NOGA MappingNOGA Mapping 16 16 Herzohrverschluss linksHerzohrverschluss links 7 7 PCI wegen instent-Restenose 737PCI wegen instent-Restenose 737
Volker Mühlberger, QualityVolker Mühlberger, Quality
Case load per physicianCase load per physician
0
50
100
150
200
250
1998
PC
I
1999
PC
I
2000
PC
I
2001
PC
I
2002
PC
I
2003
PC
I
1998
CA
1999
CA
2000
CA
2001
CA
2002
CA
2003
CA
AU
CH
Volker Mühlberger, QualityVolker Mühlberger, Quality
Case load per physician 2003Case load per physician 2003
Z1 Z9 Z11 Z12 Z13 Z15 Z17 Z18 Z19 Z21 Z23 Z24 Z25 Z26 Z27 Z29 Z30 Z31
0
100
200
300
400
36
34
32
34
32
Jahr: 2003
Volker Mühlberger, QualityVolker Mühlberger, Quality
NUMBER OF CENTERS WITH HIGH OR NUMBER OF CENTERS WITH HIGH OR LOW CASE LOAD FOR PCI DURING 2000/02LOW CASE LOAD FOR PCI DURING 2000/02
0
2
4
6
8
10
12
14
16
18
<200 PCI per yearand center
200-400 >400 PCI
AU 2000
CH 2000
AU 2001
AU 2002
AU 2003
Volker Mühlberger, QualityVolker Mühlberger, Quality
NUMBER OF CENTERS WITH HIGH OR NUMBER OF CENTERS WITH HIGH OR LOW CASE LOAD FOR CA DURING 2000/02LOW CASE LOAD FOR CA DURING 2000/02
0
2
4
6
8
10
12
14
<400 CA peryear and
center
400-1000 1000-2000 >2000 CA
AU 2000
CH 2000
AU 2001
AU 2002
AU 2003
...........wie geht’s weiter?...........wie geht’s weiter?
.....eine Validierung von Indikationskriterien für invasive Massnahmen mittels entsprechender “Output-Daten” , um nach internationalen Qualitätsmaßstäben zu beurteilen, ob die österreichischen Kardiologen ihre Ressourcen adäquat einsetzen (Pachinger Z.Kardiol 2003)
...........wie geht’s weiter?...........wie geht’s weiter?
Einer besucht alle (Auditor)Einer besucht alle (Auditor) Alle besuchen alle (Monitor)Alle besuchen alle (Monitor) Ausgebildete Auditoren besuchen..........Ausgebildete Auditoren besuchen.......... Stichproben.......................Stichproben.......................