returns2004

BCIS Audit ReturnsAdult Interventional ProceduresJan 2004 to Dec 2004 :BCIS Audit ReturnsAdult Interventional ProceduresJan 2004 to Dec 2004 Peter F Ludman BCIS National Audit Officer On behalf of British Cardiovascular Intervention Society Bristol 2005


Audit Domains :Audit Domains Structure Appropriateness Process Outcome 2004 data: Ludman


Slide 3 :Angiography Centres - 2004 19 New Angiography Only centres 2004 2004 data: Ludman


Slide 4 :North Tyneside (to Freeman Hospital) 1 Stopped 1 Swapped St Albans → fixed lab in Hemel Hempstead Angiography Centres - 2004 2004 data: Ludman 3 Started PCI in 2004 Torbay BUPA Hull Southend TOTAL: 83 Angiography Only Centres (increase of 15 from 2003)


PCI Centres - 2004 :PCI Centres - 2004 Torbay Southend BUPA Hull 3 Angio only centres now performing PCI in 2004 New PCI centres in 2003 Manor Hospital, Oxford 2004 data: Ludman TOTAL: 77 PCI Centres (increase of 4 from 2003)


UK Centres - 2004 :UK Centres - 2004


PCI Centres NHS (1) :PCI Centres NHS (1)


PCI Centres NHS (2) :PCI Centres NHS (2) England (cont)


PCI Centres NHS (3) :PCI Centres NHS (3)


PCI Centres - Private :PCI Centres - Private


Angiography Only Centres (1) :Angiography Only Centres (1)


Angiography Only Centres (2) :Angiography Only Centres (2)


Angiography Only Centres (3) :Angiography Only Centres (3)


Slide 14 :77 83 PCI centres Angiography only Centres 2004


UK Interventional and Diagnostic centres2004 :UK Interventional and Diagnostic centres2004 Missing cath data estimated from 2003 figures


PCI Centres not reporting diagnostic numbers for 2004 :PCI Centres not reporting diagnostic numbers for 2004 NHS Derriford Hospital St Mary's Hospital, London St Peter's Hospital, Chertsey (Belfast City Hospital – very late) Private BMI Park Hospital, Notts Harley Street Clinic


Angio only Centres not reporting diagnostic numbers for 2004 :Angio only Centres not reporting diagnostic numbers for 2004 Broomfield Hospital Diana Princess of Wales Hospital, Grimsby Dumfries & Galloway RI Ealing Hospital Neville Hall Hospital Queen Elizabeth Hospital, Woolwich Royal Gwent Hospital Royal Surrey County Hosp Salisbury District Hospital Wycombe Hospital South Warwickshire NHS Trust South Tyneside District Hospital


UK Interventional and Diagnostic centres2004 :UK Interventional and Diagnostic centres2004 Missing cath data estimated from 2003 figures if known


Centres Not ReportingPCI numbers for 2004 :Centres Not ReportingPCI numbers for 2004 Southend St Peter's Hospital, Chertsey (Belfast City Hospital – very late) BMI Park Hospital


UK Interventional and Diagnostic centres2004 :UK Interventional and Diagnostic centres2004 Missing cath data estimated from 2003 figures if known


PCI per Angiogram ratio :PCI per Angiogram ratio


PCI per Angiogram ratioESC Survey 2003 :PCI per Angiogram ratioESC Survey 2003 Cook S for Working Group on Interventional Cardiology (WG 10) of the ESC In Press


Total UK PCI Procedures :Total UK PCI Procedures


Rate of increase in PCI numbers pmp :Rate of increase in PCI numbers pmp


Slide 25 :PCI activity to 2004 (UK)


Total PCIs in the UK Countries :Total PCIs in the UK Countries Total No.s of PCI


Slide 27 :Population estimates Mid 2004 Scotland 5.08 m England 50.09 m Wales 2.95 m Rx in Wales: 2.25 m Northern Ireland 1.71 m Welsh Rx in England 0.7 m Total UK: 59.8 m Total Rx in England 50.79 m


PCIs/million UK Countries(2000 to 2004) :PCIs/million UK Countries(2000 to 2004)


PCI vs Isolated CABG Numbers (UK)Data from BCIS and SCTS Registry :PCI vs Isolated CABG Numbers (UK)Data from BCIS and SCTS Registry Note: CABG data for financial yr all PCI v NHS CABG CABG data for 2003 and 2004 from DoH


Slide 30 :PCI vs Isolated CABG Ratio (UK)Data from BCIS and SCTS Registry


Euro Heart Survey 3rd Report :Euro Heart Survey 3rd Report Cardiovascular Diseases in Europe 2004 www.escardio.org/knowledge/ehs/slides/


Slide 32 :Euro Heart Survey 3rd Report Cardiovascular Diseases in Europe 2004 www.escardio.org/knowledge/ehs/slides/


Annual Procedures per cath lab(NHS centres) :Annual Procedures per cath lab(NHS centres)


Number of PCIs performed in NHS Centres(Total Per Annum) :Number of PCIs performed in NHS Centres(Total Per Annum) Data from: 57 of 58 centres (2 centres estimated data)


Day Case PCI :Day Case PCI 22 of 77 Units performing day case PCI Total of 3018 procedures performed (21% increase cf 2003) 4.8% of all PCI procedures (4.6% 2003) Data from: 64 of 77 centres


No. of Interventional Consultants(NHS centres) :No. of Interventional Consultants(NHS centres) Note: if work at two NHS centres will be counted twice Includes cardiologists and radiologists Data from: 57 of 58 centres


No. of Interventional Consultants(NHS centres) :No. of Interventional Consultants(NHS centres) Mean 2000 5.5 2001 6.1 6.5 6.7 7.4


Slide 38 :Mean PCI/consultant 2000 125 2001 126 2002 138 2003 139 2004 143 No. of PCIs per Consultant (NHS Centres) 2004 data from 56 of 58 centres Note: data from institutional volume divided by No operators per institution


Visiting Interventionists(NHS Centres) 2004 data from 57 of 58 centres :Visiting Interventionists(NHS Centres) 2004 data from 57 of 58 centres


Visiting Interventionists(NHS Centres) :Visiting Interventionists(NHS Centres)


Surgical Cover(NHS Centres) :Surgical Cover(NHS Centres)


Slide 42 :Surgical Cover


STEMI :STEMI


Primary PCI for STEMI :Primary PCI for STEMI Do you offer at least some PCI for STEMI? Data from: 55 of 58 centres


Primary PCIRoutine Rx for STEMI :Primary PCIRoutine Rx for STEMI Data from: 55 of 58 centres Working Hours Only 24/7 Number of Centres


Primary PCIRoutine Rx for STEMI :Primary PCIRoutine Rx for STEMI Data from: 55 of 58 centres Working Hours Only 24/7


PCI for STEMI(2004 NHS Hospitals: data from 48 of 58 units) :PCI for STEMI(2004 NHS Hospitals: data from 48 of 58 units) 5.5% of all PCI activity


PCI for STEMI(2004 NHS Hospitals: data from 48 of 58 units) :PCI for STEMI(2004 NHS Hospitals: data from 48 of 58 units)


Slide 49 :PCI for All STEMI2004 data from 48 of 58 centres Total 3447 procedures No data


Slide 50 :PCI for All STEMI2004 data from 48 centres Total 3447 procedures


Slide 51 :Primary PCI for STEMI2004 data from 48 centres Total 1438 procedures No data


Slide 52 :Primary PCI for STEMI2004 data from 48 centres Total 1438 procedures


Primary PCI for STEMI :Primary PCI for STEMI As Percentage of Each Centre’s PCI Activity


Primary PCI – the experience :Primary PCI – the experience


Primary PCI – the experience :Primary PCI – the experience UK population 60 million, at 500 pmp = 30,000 procedures pa


Slide 56 :2.3 % 32 % 1050 pmp 1546 pmp UK Activity 2004


Slide 57 :2.3 % 32 % 1050 pmp 1546 pmp UK Growthassuming no ↑ in other PCI pmp + 30,000 PPCI


Slide 58 :2.3 % 32 % 1050 pmp 1546 pmp UK Growthassuming no ↑ in other PCI pmp


Uncertainties :Uncertainties 1546 pmp


PCI for Stable v ACS :PCI for Stable v ACS Of Total PCIs performed 44% ACS (excluding STEMI) 50% Elective


Slide 61 :PCI for Stable v ACS Of Total PCIs performed 44% ACS (excluding STEMI) 50% Elective


Audit Domains :Audit Domains Structure Appropriateness Process Outcome


Stent procedures2004 data from 60 of 77 centres :Stent procedures2004 data from 60 of 77 centres


Stenting in Different Centres :Stenting in Different Centres


Drug Eluting Stent cases2004 data from 69 of 77 centres :Drug Eluting Stent cases2004 data from 69 of 77 centres NHS and private


Drug Eluting Stent cases2004 data from 53 of 58 centres :Drug Eluting Stent cases2004 data from 53 of 58 centres NHS only


DES use by Centre (NHS) :DES use by Centre (NHS)


Drug Eluting Stent cases2004 data from 53 of 58 centres :Drug Eluting Stent cases2004 data from 53 of 58 centres


PCI for Restenosis(2004 data from 54 of 77 centres) :PCI for Restenosis(2004 data from 54 of 77 centres) Mean: 2002 4.9% 2003 4.3% 2004 3.6%


Bare Metal and DES use v PCI for Restenosis :Bare Metal and DES use v PCI for Restenosis


PCI in patients with past CABG(Data from 53 of 77 centres) :PCI in patients with past CABG(Data from 53 of 77 centres) Mean 2002 8.4% 2003 6.8% 2004 6.7% Note: Includes procedures on native vessels and grafts


Use of GP IIb/IIIa blockers2004 data from 71 of 77 centres :Use of GP IIb/IIIa blockers2004 data from 71 of 77 centres Overall mean % use


Abciximab use by Clinical Presentation :Abciximab use by Clinical Presentation


Multi-vessel TreatmentExcluding Rx of STEMI :Multi-vessel TreatmentExcluding Rx of STEMI


Multi-vessel TreatmentExcluding Rx of STEMI :Multi-vessel TreatmentExcluding Rx of STEMI


Slide 76 :Mean (Range) Multi-vessel TreatmentAll Clinical Presentations


Slide 77 :Multi-vessel TreatmentExcluding Rx of STEMI


Additional Interventional CoronaryTechniques (1)2004 data from 74 of 77 centres :Additional Interventional CoronaryTechniques (1)2004 data from 74 of 77 centres *% of all UK interventional procedures **Mean number in units using the technique


Additional Interventional CoronaryTechniques (2)2004 data from 74 of 77 centres :Additional Interventional CoronaryTechniques (2)2004 data from 74 of 77 centres


OtherInterventional Techniques2004 data from 74 of 77 centres :OtherInterventional Techniques2004 data from 74 of 77 centres


Slide 81 :Alcohol Mediated Septal Ablation(HOCM) Total 57 procedures


Other Diagnostic Techniques2004 data from 74 of 77 centres :Other Diagnostic Techniques2004 data from 74 of 77 centres


Adult non coronary intervention2004 data from 74 of 77 centres :Adult non coronary intervention2004 data from 74 of 77 centres


Mitral Balloon Valvuloplasty :Mitral Balloon Valvuloplasty Total 165


Adult great vessel intervention2004 data from 74 of 77 centres :Adult great vessel intervention2004 data from 74 of 77 centres


Other procedures2004 data from 74 of 77 centres :Other procedures2004 data from 74 of 77 centres


Radial Artery Access :Radial Artery Access 6457 cases: 10.2% of all PCI Data from: 68 of 77 centres


Femoral artery closure devices2004 data from 69 of 77 centres :Femoral artery closure devices2004 data from 69 of 77 centres Mean: 45%


Audit Domains :Audit Domains Structure Appropriateness Process Outcome


Data to end of Procedure only2004 data :Data to end of Procedure only2004 data


Mortality - All PCIsTo end of PCI or hosp discharge :Mortality - All PCIsTo end of PCI or hosp discharge


MACE - All PCIsTo end of PCI or hosp discharge :MACE - All PCIsTo end of PCI or hosp discharge


All Procedures: Outcome :All Procedures: Outcome


Data on HOSPITAL outcome(2004 data 43 of 77 sites) :Data on HOSPITAL outcome(2004 data 43 of 77 sites)


Data on HOSPITAL outcome(2004 data 43 of 77 sites) :Data on HOSPITAL outcome(2004 data 43 of 77 sites)


Data on HOSPITAL outcome(2004 data 43 of 77 sites) :Data on HOSPITAL outcome(2004 data 43 of 77 sites) Some additional centres have provided CCAD data but not form C


Data on HOSPITAL outcome(2004 data 35 of 77 sites) :Data on HOSPITAL outcome(2004 data 35 of 77 sites)


Hospital Outcome 2004Data from 43 centres :Hospital Outcome 2004Data from 43 centres All Patients


Hospital Outcome 2004Data from 37 to 40 centres :Hospital Outcome 2004Data from 37 to 40 centres Elective Patients


Hospital Outcome 2004Data from 34 to 37 centres :Hospital Outcome 2004Data from 34 to 37 centres Does not account for clinical syndrome CABG patients includes Rx of native and grafts Patients with previous bypass grafts Patients treated for restenosis


Hospital Outcome 2004Data from 28 to 30 centres :Hospital Outcome 2004Data from 28 to 30 centres Patients Rx for acute vessel closure Equivalent to SAT rate 0.32% - likely underestimate


Hospital Outcome 2004Data from 36 to 38 centres :Hospital Outcome 2004Data from 36 to 38 centres UA and NSTEMI Includes all classified as treated for UA and post MI angina (stable and unstable)


Hospital Outcome 2004Data from 30 to 32 centres :Hospital Outcome 2004Data from 30 to 32 centres Patients Rx for STEMI


Summary: In Hospital MortalityRisk Stratified by Syndrome(Data from approx 43,000 patients) :Summary: In Hospital MortalityRisk Stratified by Syndrome(Data from approx 43,000 patients)


In Hospital Mortality by Syndrome(Data from approx 43,000 patients) :In Hospital Mortality by Syndrome(Data from approx 43,000 patients)


Emergency CABG by Syndrome(Data from approx 43,000 patients) :Emergency CABG by Syndrome(Data from approx 43,000 patients)


Late Events post Discharge :Late Events post Discharge BCIS - CCAD


BCIS / CCAD projectThe Vision :BCIS / CCAD projectThe Vision Hospital 1 Hospital 2 Hospital 3 Hospital n CCAD Server encryption Internet encryption encryption encryption . .


BCIS / CCAD projectThe Vision :BCIS / CCAD projectThe Vision Hospital 1 Hospital 2 Hospital 3 Hospital n CCAD Server encryption Internet encryption encryption encryption . . Hospital 1 v All Others Hospital 2 v All Others


BCIS / CCAD projectThe Vision :BCIS / CCAD projectThe Vision CCAD Server ONS tracking Crosslink (NHS No.) BCIS SCTS MINAP EP / ICD Pacing Patient outcome Advanced Analysis Risk stratified Appropriateness Process Outcome Device monitoring etc. Publication strategy


Downloading to CCADSeptember 2005 :Downloading to CCADSeptember 2005 21 Centres


Slide 112 :Some Data to CCADSeptember 2005 Total 28 Centres


NO Data to CCADSeptember 2005 :NO Data to CCADSeptember 2005 26 Centres


Monthly CCAD dataJan 2004 to Sept 2005 :Monthly CCAD dataJan 2004 to Sept 2005


Total Data in CCADto Sept 2005 :Total Data in CCADto Sept 2005


Tracking via CCAD :Tracking via CCAD Data completeness NHS numbers National Average 63% MINAP 87% SCTS 83% 24,073 PCI Procedures 15,250 Successful ONS tracking


Length of follow-up(tracking performed July 2005) :Length of follow-up(tracking performed July 2005) Median = 362 days


Slide 118 :Survival after Any PCI(tracking performed July 2005) In Hospital †: 0.61% Subsequent †: 3.0% Approx 1.7% pa


Survival after Elective PCI(tracking performed July 2005) :Survival after Elective PCI(tracking performed July 2005) 2005 Approx 1 % pa


Survival after PCI for UA / NSTEMIby Procedure Urgency :urgent emergency salvage Survival after PCI for UA / NSTEMIby Procedure Urgency (tracking performed July 2005)


Slide 121 :No shock shock Survival after PCIAll Shock (tracking performed July 2005)


Slide 122 :Non-STEMI STEMI p<0.0001 Survival after PCI for ACSSTEMI v NSTEMI / UA Shock excluded (tracking performed July 2005)


Slide 123 :Non-STEMI STEMI p<0.0001 Survival after PCI for ACSSTEMI v NSTEMI / UA Shock excluded (tracking performed July 2005)


Slide 124 :Non-STEMI STEMI Shock Survival after PCI for ACSSTEMI v NSTEMI / UA v Shock (tracking performed July 2005)


Admission with ACS after PCI(any PCI indication) :Admission with ACS after PCI(any PCI indication) Patients with an exit diagnosis of ACS (tracking performed July 2005)


Slide 126 :Non-STEMI STEMI Shock p=n.s. Patients with an exit diagnosis of ACS (tracking performed July 2005) Re-admission with ACS after PCISTEMI v NSTEMI v Shock


Slide 127 :Events: death, ACS admission, redo PCI, cardiac surgery Event free survival after PCIAll Cases (tracking performed July 2005) 87% 1 yr 83% 2 yr


Slide 128 :Events: death, ACS admission, redo PCI, cardiac surgery ACS: non-STEMI ACS: STEMI Shock Stable Event free survival after PCI (tracking performed July 2005)


Summary :Summary 77 PCI centres in UK 1050 PCI pmp in UK Cath : PCI = 31.3% PCI : CABG = 2.5 : 1 MACE Stable syndromes mortality 0.24%, CABG 0.25% UA / NSTEMI Mortality 0.75%, CABG 0.21% BCIS – CCAD A new dawn