2003 data: Ludman BCIS Audit Returns Adult Interventional Procedures 2003 Peter F Ludman BCIS...

2003 data: Ludman

BCIS Audit ReturnsAdult Interventional Procedures

2003

Peter F Ludman

BCIS National Audit OfficerOn behalf of

British Cardiovascular Intervention Society

York 2004

2003 data: Ludman

Audit Domains

• Structure

• Appropriateness

• Process

• Outcome

2003 data: Ludman

Audit Domains

• Structure– The Centres– Work patterns– Activity

• Appropriateness• Process• Outcome

2003 data: Ludman

7 New Angiography Centres

– Worcester– Harrogate– Prince Philip, Llanelli– Princess Alex Univ Hosp, Bromley– Chelmsford– Droitwich Spa– Wycombe

– Raigmore, Inverness*– Worthing*– Goring Hall*

New Angiography only centres 2003

*new to database, but angiography for some yrs

2003 data: Ludman

9 New PCI Centres

– Battle, Reading– Cheltenham– New Cross– Basingstoke– Northwick Park– Sandwell (restart)– St Peters, Chertsey– BUPA Southampton

Angiography centres now performing PCI in 2003

New PCI centres in 2003– Leeds Nuffield

2003 data: Ludman

UK Intervention Centres

52 52 53 54 54 5358 61 63 66 64 64

73

0

10

20

30

40

50

60

70

80

No

.ce

ntr

es

2003 data: Ludman

73

68

PCI centres

Angiography onlyCentres

2003

2003 data: Ludman

Scotland

2003 data: Ludman

Wales

2003 data: Ludman

N. Ireland

2003 data: Ludman

England - PCI

2003 data: Ludman

England

2003 data: Ludman

Audit Domains

• Structure– The Centres– Work patterns– Activity

• Appropriateness• Process• Outcome

2003 data: Ludman

UK Interventional and Diagnostic centres2003

No. No cath data

No PCI data

Caths(% of total)

PCIs(% of total)

NHS Interventional

56 3 1 135,547(72%)

51,038(94%)

Private Interventional

17 2 0 11,115(6%)

3,469(6%)

Diagnostic only

68 2 40,457(22%)

TOTAL 141 187,119 54,507

Missing cath data estimated from 2002 figures

2003 data: Ludman

Centres not reporting diagnostic numbers

• Interventional

– Edinburgh RI– Northwick Park Hospital– New Cross Hospital

– BUPA Hospital Leeds– BMI Park Hospital, Notts

• Diagnostic only– Dumfries & Galloway RI– Royal Surrey County Hosp

2003 data: Ludman

Centres not reporting PCI numbers

• Northwick Park Hospital

2003 data: Ludman

UK Interventional and Diagnostic centres2003

No. No cath data

No PCI data

Caths(% of total)

PCIs(% of total)

NHS Interventional

56 3 1 135,547(72%)

49,542(93%)

Private Interventional

17 2 0 11,115(6%)

3,719(6%)

Diagnostic only

68 2 40,457(22%)

TOTAL 141 187,119 53,261

Missing cath data estimated from 2002 figures

2003 data: Ludman

Angiograms per PCI

5.2

4.3

5.7

3.84.1

3.5

4.3

2.8

4

2.8

3.7

2.8

3.53

0

1

2

3

4

5

6

1997 1998 1999 2000 2001 2002 2003

Angio/PCI (PCI centres)

Angio/PCI (all UK)

2003 data: Ludman

Annual Procedures per cath lab(NHS centres)

Mean Median Range

Interventional labs

Procedures (pa)per lab

1224 1126 489 to 2481

PCIs (pa) per lab

412 393 28 to 844

Diagnostic labs

Caths (pa) per lab* 604 487 43 to 2800

2003 data: Ludman

Day Case Procedures• 29 of 73 Units performing day case PCI

– Total of 2492 procedures performed

• 4.6% of all PCI procedures

53

5 2 1 0 2 0 1 0 0 1 00

10

20

30

40

50

60

Nu

mb

er

of

Cen

tres

0-50 51-100

101-150

151-200

201-250

251-300

301-350

351-400

401-450

451-500

501-550

551-600

Cases per centre

2003 data: Ludman

Interventional centres providing NO DATA

• Northwick Park Hospital

2003 data: Ludman

Number of PCIs performed in NHS Centres(total per annum)

0

2

4

6

8

10

12

<200 <400 <600 <800 <1000 <1200 <1400 <1600 <1800 <2000 <2200 <2400 >2400

2000

2001

2002

2003

2003 data: Ludman

590664

759

894

0

100

200

300

400

500

600

700

800

900

Rate per Million

'85 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03

Year

PCI Rates per million population (UK)

Assumes UK population of:58.8 m mid 2001, 59.2m mid 2002, 59.6 mid 2003

2003 data: Ludman

Rate of increase in Procedure numbers per million

0

5

10

15

20

25

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Rat

e o

f In

crea

se (

%)

2003 data: Ludman

Total UK PCI ProceduresYear Centres Total

Procedures Rate per million Increase

(%) 1991 52 9,933 174 1992 52 11,575 203 16.5 1993 53 12,937 227 11.8 1994 54 14,624 256 13.0 1995 54 17,344 304 18.6 1996 53 20,511 359 18.1 1997 58 22,902 402 11.7 1998 61 24,899 437 8.7 1999 63 28,133 494 13 2000 66 33,652 590 20 2001 64 38,992 664 12.5 2002 64 44,913 759 14.3 2003 73 53,261 894 17.8

2003 data: Ludman

Total PCIs in the UK Countries(2000 to 2003)

886119

42234

922137711830072618

25610

135

30785

154234852159 1131

1498

40722787

35306

3396110

44381775

1308

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

EnglandNHS

EnglandPrivate

ScotlandNHS

ScotlandPrivate

N. Ireland Wales

2000200120022003

Total No.s of PCI

2003 data: Ludman

Population estimatesMid 2003

Scotland 5.06 m

England 49.86 m

Wales 2.94 mRx in Wales: 2.21 m

Northern Ireland 1.70 m

Welsh Rx in England 0.696 m

Total UK: 59.6 m

Total Rx in England 50.55 m

2003 data: Ludman

PCIs/million UK Countries(2000 to 2004)

903 899

1044

592

0

200

400

600

800

1000

1200

England Scotland N. Ireland Wales

2000200120022003

NB Assume 2.21 m population Rx in Wales

2003 data: Ludman

PCI vs Isolated CABG Numbers (UK)Data from BCIS and SCTS Registry

0

10000

20000

30000

40000

50000

60000

'91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03

BCISSCTS

PCI:CABG 1.3 1.6 1.8 2.1*

*assumes no increase in CABG

Note: CABG data for financial yrall PCI v NHS CABG

2003 data: Ludman

No. of Interventional Consultants(NHS centres) data from 54 of 56 centres

0

2

4

6

8

10

12

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

No of Consultants per Centre

No

of

Cen

tres

2002

2003

Mean2000 5.52001 6.12002 6.52003 6.7

Total = 362 (↑16%)Includes local and visitors, cardiologists and radiologists

2003 data: Ludman

No. of PCIs per Consultant (NHS Centres) 2003 data from 54 of 56 centres

0

5

10

15

20

25

No

of

Cen

tres

0-50 51-100 101-150 151-200 201-250 >250

No PCIs/Consultant

2001 2002 2003

Note: data from institutional volume divided by No operators per institution

Mean PCI/consultant:2000 1252001 1262002 1382003 139

2003 data: Ludman

Visiting Interventionists(NHS Centres) 2003 data from 54 of 56 centres

0

10

20

30

40

No Visitors Visitors

Type of Centre

Number of

centres

2002

2003

2003 data: Ludman


88

139 135

020406080

100120140

Nu

mb

er

of

Op

era

tors

No visitors With visitors

Type of Centre

Local operators

Visitingoperators

2003 data: Ludman


162155 132 130

0

50

100

150

200

PC

Is p

er

op

era

tor

No visitors Visitors

Type of Centre

MedianMean

2003 data: Ludman


4.6 5

7.8 7

0

2

4

6

8

10

Mea

n N

o. o

f O

per

ato

rs p

er

cen

tre

No visitors Visitors

Type of Centre

Mean

Median

2003 data: Ludman

Surgical cover

On site Off siteNo of centres 55

(76%)

17(24%)

No. of PCI

(% of total)46083

(87%)

6928(13%)

Mean No. procedures

per centre 853 407

Operator volume:

PCIs per interventionist *157 90

* NHS Centres only

2003 data: Ludman

Off Site Surgical cover

0

1

2

3

4

No. of Centres

0-50

51-1

00

101-

150

151-

200

251-

300

301-

350

351-

400

451-

500

551-

600

601-

650

651-

700

>701

No. Procedures per Centre

2003 data: Ludman

PCI for STEMI(2003 data from 50 of 73 units)

2304

633

1060

416278

0

500

1000

1500

2000

2500

All STEMI PrimaryPCI

Rescue For Re-MI Shock

2001

2002

2003

Data from units reporting cath or hosp outcome

4.3% of all PCI activity

2003 data: Ludman

PCI for All STEMI2003 data from 43 centres

0

2

4

6

8

10

12

Number of Centres

No. of Procedures per Centre

All centres24-7 STEMI RxDay STEMI Rx

Total 2304 procedures

2003 data: Ludman

Primary PCI for STEMI2003 data from 43 centres

0

5

10

15

20

Nu

mb

er

of

Ce

ntr

es

0-10 11-20 21-40 41-50 51-60 61-70 71-80 81-90 91-100 >100

No Procedures per Centre

Total 633 procedures

2003 data: Ludman

Audit Domains

• Structure

• Appropriateness

• Process

• Outcome

2003 data: Ludman

Minimum Data (Q10 to 15)

Minimal or No data from:

• Northwick Park Hospital• BUPA Hospital Leeds

2003 data: Ludman

Stent procedures2003 data from 53 of 73 centres

84 86 89.4 92.1

0102030405060708090

100

% of Procedures

'92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03

Year

2003 data: Ludman

Stenting in different centres2003 data from 53 of 73 centres

0

5

10

15

20

25

30

35

40

No

of

Cen

tres

31-40 41-50 51-60 61-70 71-80 81-90 >90

% Procedures per centre using Stents

1998

1999

2000

2001

2002

2003

2003 data: Ludman

Drug Eluting Stent cases2003 data from 64 of 73 centres

? ?

17

28

0

10

20

30

40

50

% D

ES

ca

se

s

2002 2003

MeanMedian

2003 data: Ludman


0

5

10

15

20

25

30

Number of Centres

0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100

% Procedures per centre using DES

All

NHS

Private

2003 data: Ludman


5.3

18.3

28.6

49.76

0

10

20

30

40

50%

DE

S C

as

es

Scotland England Wales N. Ireland

Country

2003 data: Ludman

PCI for Restenosis(2003 data from 58 of 73 centres)

0%

10%

20%

30%

40%

50%

60%

70%

% of Centres

0-5 5.1-10 10.1-15 >15

% procedures for Restenosis

199819992000200120022003

Mean 2003: 4.3%

2003 data: Ludman

PCI in patients with past CABG(Data from 57 of 73 centres)

0

5

10

15

20

25

30

No of Centres

0 to 5 5.1 to 10 10.1 to 15 15.1 to 20 20.1 to 25 25.1 to 30

% of procedures per centre in patient with CABG

Note: Includes procedures on native vessels and grafts

Mean 2002 8.4%2003 6.8%

2003 data: Ludman

Use of GP IIb/IIIa blockers2003 data from 66 of 73 centres

48.4

05

101520253035404550

% of Procedures

1997 1998 1999 2000 2001 2002 2003

with Abciximabwith any GPIIb/IIIa

Overall mean % use

2003 data: Ludman

Abciximab in different centres 1999 - 2003

2003 data from 66 of 73 centres

0

5

10

15

20

25

30

No. of Centres

0 to

10

11 to

20

21 to

30

31 to

40

41 to

50

51 to

60

61 to

70

71 to

80

81 to

90

>90

% Procedures per centre using Abciximab

1999

2000

2001

2002

2003

2003 data: Ludman

Abciximab use by Clinical Presentation

35.6

55.8

36.1

55.4 56

67

01020304050607080

% Procedures with

Abciximab 20022003

2003 data: Ludman

Multivessel Treatment• Non STEMI cases

79 77 73 72

21 23 27 28

0

10

20

30

40

50

60

70

80

90

100

2000 2001 2002 2003

% C

ases MV

SV

2003 data: Ludman

Multivessel Treatment

1.21 1.23 1.231.27

11.11.21.31.41.51.61.71.81.9

2

2000 2001 2002 2003

Ves

sels

/C

ase

(cen

tre

dat

a)

Mean (Range)

2003 data: Ludman

Additional Interventional CoronaryTechniques (1)


Units No∆ % cf 2002

* % of all procs

Mean** Range

Rotablation 31 288 +69% 0.54 9.3 1-69

Atherctmy (DCA) 7 15 +15% 0.03 2.1 1-6

TEC 3 3 -75% 0.006 1 1

Laser 3 22 +47% 0.04 7.3 1-12

Cutting balloon 49 1330 +8.5% 2.5 27.1 1-198

*% of all UK interventional procedures**Mean number in units using the technique

2003 data: Ludman

Additional Interventional CoronaryTechniques (2)


Units No∆ cf 2002

% of all procs

Mean Range

Thrombectomy ¥ 30 347 +136% 0.65 11.6 1-92

Distal protection 32 345 0.65 10.8 1-101

Brachytherapy 8 118 -17.5% 0.22 14.75 1-33

¥PercuSurge, Rescue, Angiojet, X-sizer

2003 data: Ludman

OtherInterventional Techniques


Units No*∆ cf 2002

% of all procedures

Mean Range

PTMR 2 18 0.03 9 1-17

Septal ablation 16 57 0.1 3.6 1-20

*Not requested last yr, so comparison misleading and omitted

2003 data: Ludman

Other Diagnostic Techniques2003 data from 70 of 73 centres

Units No∆ cf 2002

% of all procedures

Mean Range

IVUS 37 771 12% 1.5 20.8 1-131

Press wire 38 926 1.7 24.4 1-139

Flow wire 6 8 0.01 1.3 1-2

2003 data: Ludman

Adult non coronary intervention2003 data from 70 of 73 centres

Units No∆ cf 2002

% of all procedures

Mean Range

MV plasty 35 230 +15% 0.43 6 1-29

AV plasty 8 17 +183% 0.03 2.1 1-4

PV plasty 10 25 -3.8% 0.05 2.5 1-5

TV plasty 0

PDA 9 38 +65% 0.07 4.2 1-11

ASD 27 450 +34% 0.85 16.7 2-54

PFO 22 195 +110 0.37 8.9 1-73

VSD 13 32 0.06 2.5 1-10

2003 data: Ludman

Mitral Balloon Valvuloplasty

21

6 5

1 00

5

10

15

20

25

Number of centres

1-5 6-10 11-15 16-20 21-25

No. of Procedures per Centre

20022003

2003 data: Ludman

Adult great vessel intervention2003 data from 70 of 73 centres

Units No∆ cf 2002

% of all procedures

Mean Range

Coarct / Re-coart 13 89 +170% 0.16 6.8 1-24

Carotid 4 27 -64% 0.05 6.8 1-22

Aorta 4 12 0.02 3 1-6

Pulm art 8 31 0.06 3.9 1-8

SVC 10 59 0.11 5.9 1-24

2003 data: Ludman

Other procedures2003 data from 70 of 73 centres

Units No∆ % cf 2002

% of all procs

Mean Range

Foreign body removal

3 28 +75% 0.05 9.3 2-23

Embolisation 9 45 +87% 0.08 3 1-9

Balloon

Pericardiotomy

3 14 0.02 4.7 1-11

Spinal cord stimulator

4 13 0.02 3.3 1-6

2003 data: Ludman

Femoral artery closure devices2003 data from 55 of 73 centres

0123456789

10

Nu

mb

er

of

Ce

ntr

es

0-10 11-20

21-30

31-40

41-50

51-60

61-70

71-80

81-90

91-100

% Use of Device per Centre

Mean: 47%

2003 data: Ludman

Audit Domains

• Structure

• Appropriateness

• Process

• Outcome

2003 data: Ludman

ANY Outcome Data (form C)

Inadequate or No Data

• Freeman Hospital• London Chest Hospital• St Bartholomew's• Northwick Park Hospital• St Peter's Hospital• University Hospital of

Wales

• BMI Priory Hospital• BUPA Hospital Leeds• London Independent

Hospital• Ross Hall Hospital• St Anthony's

2003 data: Ludman

Data to end of Procedure onlyfrom 35 of 73:

Battle Hospital

Belfast City Hospital

Birmingham City Hospital

Birmingham Heartlands Hospital

City General Hospital

Derriford Hospital

Eastbourne Hospital

Glasgow Royal Infirmary

Glasgow Western Infirmary

Hairmyres Hospital

London Chest Hospital

Manchester Royal Infirmary

Morriston Hospital

North Hampshire Hospital

Northern General Hospital

Northwick Park Hospital

Royal Cornwall Hospital

Royal Free Hospital

St Bartholomew's Hospital

St Mary's Hospital

St Peter's Hospital

University Hospital of Wales

Victoria Hospital

BMI Alexandra Hospital

BMI Priory Hospital

BUPA Cambridge Lea Hospital

BUPA Hospital Leeds

BUPA Hospital Leicester

Cromwell Hospital

Golden Jubilee National Hospital (formerly HCI)

Leeds Nuffield Hospital

London Independent Hospital

Ross Hall Hospital

St Anthony's Hospital

The Yorkshire Clinic

Wellington Hospital

2003 data: Ludman

All PCI Procedures: Mortality Year Data

From: Total with

mortality data Mortality % Range %

1991 9,071 (9,933) 0.48

1992 43/52 10,483 (11,575) 0.71 0-3.5

1993 44/53 11,859 (12,937) 0.59 0-2.7

1994 44/54 12,598 (14,624) 0.60 0-2.7

1995 35/54 11,365 (17,344) 0.69 0-3.4

1996 37/53 14,476 (20,511) 0.72 0-3.2

1997 41/58 17,577 (22,902) 0.91 0-10

1998 44/61 16,946 (24,899) 0.80 0-9.1

1999 48/63 20,975 (28,133) 0.61 0-4

2000 48/66 24,323 (33,652) 0.64 0-2.6

2001 45/64 29,001 (38,992) 0.75 0-2.8

2002 53/64 37,437 (44,913) 0.54 0-1.9

2003 64/73 49,194 (53,261)

0.53 0-2.0

Includes all centres reporting cath lab outcome or hospital outcome

2003 data: Ludman

Mortality2003 data from 64 of 73 centres

0

5

10

15

20

25

Nu

mb

er

of

Ce

ntr

es

Mortality (%)

2003 data: Ludman

All Procedures: Outcome

0.0

0.5

1.0

1.5

2.0

2.5

3.0

'91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03

%Mortality

em CABG

2003 data: Ludman

All PCI procedures: OutcomeYear Success

(%) MI (%)

Re PCI for acute closure (%)

Em. CABG (%)

Mortality (%)

1991 86 1.6 2.6 0.48

1992 88 1.4 2.0 0.71 1993 89 1.1 1.9 0.59 1994 90 1.0 1.6 0.60 1995 89 1.4 1.9 0.69 1996 90 1.4 1.7 0.72 1997 92 1.2 1.1 0.89 1998 92 0.8 0.7 0.80

1999 90 0.57 0.48 0.61

2000 92 0.6 0.4 0.64

2001 94 0.5 0.4 0.75

2002 92 (51 of 64)

0.57 (49 of 64)

0.33 (50 of 64)

0.28 (53 of 64)

0.54 (53 of 64)

2003 92 (62 of 73)

0.36 (56 of 73)

0.17 (62 of 73)

0.29 (64 of 73)

0.53 (64 of 73)

Includes all centres reporting cath lab outcome or hospital outcome

2003 data: Ludman

Stenting and the need for emergency CABG

(2002 data from 53 of 64 centres)

0

10

20

30

40

50

60

70

80

90

100

'92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03

Year

% s

ten

t

0

0.5

1

1.5

2

2.5

% E

m C

AB

G

% Stent

% Em.CABG

2003 data: Ludman

Stenting and procedures for restenosis

(2002 data from 48 of 64 centres)

0

10

20

30

40

50

60

70

80

90

100

'92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03

Year

%

0

2

4

6

8

10

12

14

%

% Stent

% Restenosis

2003 data: Ludman

Data on HOSPITAL outcome(2003 data 36 of 73 sites)

Aberdeen Royal Infirmary

Bristol Royal Infirmary

Cheltenham General Hospital

Edinburgh Royal Infirmary

Freeman Hospital

Glenfield Hospital

Hammersmith Hospital

Harefield Hospital

Heart Hospital

Hull Royal and Castle Hill Hospital

John Radcliffe Hospital

King Edward VII

Kings College Hospital

Liverpool Cardiothoracic Centre

New Cross Hospital

Nottingham City Hospital

Papworth Hospital

Queen Elizabeth Hospital, Birmingham

Royal Brompton & Harefield NHS Trust

Royal Devon & Exeter Hospital

Royal Sussex County Hospital

Royal Victoria Hospital

Sandwell District General Hospital

Southampton General Hospital

St George's Hospital

St Thomas' Hospital

Taunton & Somerset

The James Cook University Hospital

Walsgrave Hospital

Western General Hospital

Wythenshawe Hospital

Yorkshire Heart Centre

BMI Park Hospital

BUPA Hospital Bristol

BUPA Hospital Southampton

Harley Street Clinic

London Bridge Hospital

2003 data: Ludman

Hospital Outcome 2003Data from 35 centres

No.

Success Partial Success

Failed Repeat PCI

CABG MI Death (Range)

32,950 92.3% 2.9% 3.6% 0.2% 0.32% 0.4% 0.63%

(83-100) (0-11) (0-7.6) (0-1.0) (0-4.5) (0-2.5) (0-2.0)

All Patients

2003 data: Ludman


No.


Repeat PCI


Stable Single Vessel (no CTO)

12035 96% (87-100)

1.2% (0-7)

0.1% (0-0.6)

0.17% (0-1.4)

0.3% (0-3)

0.1% (0-1.5)

Stable Multivessel (no CTO)

3807 93.9% (78-100)

5.1% (0-22)

0.1% (0-2)

0.29% (0-0.3)

0.7% (0-1)

0.07% (0-1)

Single Vessel CTO

1580 64% (9-92)

4.9% (0-42)

0.04% (0-1.4)

1.9% (0-5.4)

0.5% (0-7)

0.05% (0-1.7)

Multivessel Inc. CTO

1097 73% (0-100)

21% (0-100)

0%

0.7% (0-20)

0.2% (0-5)

0.04% (0-1.1)

Elective Patients

2003 data: Ludman


No.


Repeat PCI


CABG pts 2259 88.9%

(0-100) 3.5% (0-23)

0.26% (0-5.1)

0.1% (0-1.8)

0.6% (0-4.8)

0.3% (0-2.7)

Restenosis

1490 93%

(50-100) 1.7%

(0-9) 0.6% (0-15)

0.08% (0-1.5)

0.13% (0-2.4)

2.1% (0-50)

Does not account for clinical syndromeCABG patients includes Rx of native and grafts

Patients with previous bypass graftsPatients treated for restenosis

2003 data: Ludman


No. Success Partial Success

Repeat PCI

CABG Q MI Death (Range)

ACS 10743 93.3% 3.0% 0.27% 0.15% 1.7% 0.71%

(88-100) (0-8) (0-2.7) (0-0.96) (0-29) (0-2.2)

Acute coronary syndromes (UA/NSTEMI)

Includes all classified as treated for UA and post MI angina (stable and unstable)

2003 data: Ludman


No. Success Partial Success

Repeat PCI

CABG Q MI Death (Range)

Acute closure

124 74.8% 16.1% 12.3% 1.0% 7.9% 9.4%

(0-100) (0-100) (0-100) (0-16) (0-83) (0-66)

Patients Rx for acute vessel closure

? SAT rate 0.23%

2003 data: Ludman


No.


Repeat PCI

CABG re-MI Death (Range)

Primary PTCA

475 83% (0-100)

2.7% (0-20)

1.1% (0-14)

0.4% (0-0.6)

0.5% (0-6)

4.5% (0-20)

Rescue PTCA

784 89% (40-100)

3.2% (0-14)

0.7% (0-6.7)

0.5% (0-7.7)

0.6% (0-8)

5.4% (0-60)

Re-MI PTCA

345 94.8% (80-100)

2.0% (0-50)

0.4% (0-7)

0.8% (0-20)

1.5% (0-20)

0.24% (0-6)

Shock 218 61% (0-100)

3.7% (0-33)

3.0% (0-67)

4.3% (0-67)

12% (0-100)

36.3% (0-100)

Patients Rx for STEMI

2003 data: Ludman

Hospital MACE Overview 2003(Data from 35 centres; 32,950 patients)

0.630.32 0.120.180.71

0.15

9.4

1

4.5

0.4

5.4

0.5

0123456789

10

% Mortality

em CABG

2003 data: Ludman

Hospital MACE Overview 2003(Data from 35 centres; 32,950 patients)

0

5

10

15

20

25

30

35

40

%

All

Elect

ive

UA/NSTEM

ISAT

PPTCA

Rescu

e

Shock

Mortality

em CABG

2003 data: Ludman

CCAD

• Pilot

• Governance

• Current position

• First Wave Roll Out

2003 data: Ludman

Stable Syndromes

Acute STEMI syndromes

Clarification of Indication for InterventionDataset 5.1.2 - Question 2.02

Confusion

2003 data: Ludman

Should include ALL ACS that are not acute STEMIi.e.Unstable anginaNSTEMIConvalescent STEMI

Misleading

2003 data: Ludman

New explanation:Acute coronary syndrome with or without enzyme release and a history typical of acute myocardial infarction.

Patients whose initial presentation was STEMI, but whose PCI is being performed later during the hospital stay are included in this group.

(Excludes patients having PCI for an ongoing STEMI which are coded 4 to 8).

New Description:3. ACS - UA, NSTEMI or convalescent STEMI

2003 data: Ludman

New text in red

2003 data: Ludman

CCAD

• Pilot

• Governance



2003 data: Ludman www.BCIS.org.uk and NHSIA web site

2003 data: Ludman

Governance of CCADTripartite PCI Oversight Group

Healthcare CommissionJohnathan BoyceTBA

Department of HealthRoger BoyleGavin Larner

BCISPresident – Keith Dawkins / Martyn ThomasAudit secretary – Peter LudmanScottish Representative – Keith Oldroyd

Observers:NCASP / CCADDavid Cunningham

2003 data: Ludman

Tripartite PCI Oversight Group

• Safeguard confidentiality of– patients / professionals / institutions

• Make CCAD an authoritative source of PCI data

• Provide HC with information and analysis– to give public accurate / accessible information on PCI

outcomes

• Consider modifications to the dataset

Terms of reference

2003 data: Ludman


• Confidentiality– Data / analyses will not be communicated without explicit

consent of Group– Data used to demonstrate / promote CCAD will have patients

/ professionals and institutions anonymised– CCAD will log all central uses of the local encryption keys

• Respect – data will not be used to unfairly represent an individual or

institution

Principles

2003 data: Ludman


• Publication– presented in such a way as to promote greater

public understanding and improve patient care

• Defensive Practice– Analyses will be sensitive to the risks of

promoting defensive practice to the detriment of patients

• Independence– data analyses by independent and authoritative

unit

• UK wide if possible

Principles (cont)

2003 data: Ludman

Service Level Agreement

NHS Information AuthorityNational Clinical Audit Support Programme (NCASP)

BCIS

2003 data: Ludman

Service Level Agreement

• Nuts and bolts– Harvesting / transmission / validation / cleaning of data

• Provision of real time feedback– PCI centres can compare themselves against national

anonymised data

• Administration and coordination of the service– CCAD (on behalf of NCSP)

2003 data: Ludman

Tripartite PCI Oversight group

NHS centresUK? Private Centres

CCAD tool

Data

Independent analysis

Annual Presentation (Autumn meeting)Other analyses

(Mortality ONS, re-PCI, CABG)

BCISDoHHCPublic

NHSIA

2003 data: Ludman

CCAD

• Pilot

• Governance



2003 data: Ludman

Centres downloading to CCADas of Oct 2004

James Cook University Hosp Regular

Queen Elizabeth Birmingham Regular

Leeds General Infirmary Regular

Torbay Regular

Bristol Intermit

King College, London Intermit

Royal Brompton Intermit

2003 data: Ludman

CCAD

• Pilot

• Governance



2003 data: Ludman

CCAD 1st wave roll out

2003 data: Ludman

CCAD tool: Local v National

N.B. test data only

2003 data: Ludman

BCIS - CCAD

• Try to have all PCI units returning data via CCAD by April 2005

2003 data: Ludman

Summary• 73 PCI centres in UK• 894 PCI pmp in UK• Cath : PCI = 3.53 : 1• PCI : CABG = 2.1 : 1• MACE

– Stable syndromes• mortality 0.12%, CABG 0.18%

– UA / NSTEMI• Mortality 0.71%, CABG 0.15%

• BCIS – CCAD– great progress

2003 data: Ludman BCIS Audit Returns Adult Interventional Procedures 2003 Peter F Ludman BCIS...

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