Why have a national database? Ben Bridgewater Cardiac surgeon and lead clinician, UHSM, Manchester Honorary Reader, Manchester University and Manchester Academic Health Science Centre Clinical Lead for SCTS, NICOR, UCL Chair SCTS database committee Chair EACTS database committee

Monitoring trends Supporting quality improvement Clinical governance Tracking new procedures Research substrate What we do

Supporting shared decision making for patients Improving overall quality Advancing knowledge Improving the reputation of cardiac surgery Increasing the profile and influence of the professional society Benefits

Trends SCTS database – approx 500,000 records Blue Book in 2009 Next Blue book in preparation Comprehensive analysis of trends and outcomes in cardiac surgery

Trends in cardiac surgery –Activity

Trends in cardiac surgery –Activity –Casemix

Trends in cardiac surgery –Activity –Casemix –Risk factors

Trends in cardiac surgery –Activity –Casemix –Risk factors

Trends in cardiac surgery –Activity –Casemix –Risk factors –Outcomes - mortality

Trends in cardiac surgery –Activity –Casemix –Risk factors –Outcomes - mortality

Trends in cardiac surgery –Activity –Casemix –Risk factors –Outcomes – mortality –Outcomes - other

Trends in cardiac surgery –Activity –Casemix –Risk factors –Outcomes – mortality –Outcomes – other –Techniques

Trends in cardiac surgery –Activity –Casemix –Risk factors –Outcomes – mortality –Outcomes – other –Techniques

Quality Improvement Mortality analyses Other analyses

CABG clinical outcomes Mortality Survival In-hospital complications Length of stay Angina recurrence

Clinical Governance Risk adjusted mortality rates

Results

Explanation of divergence

What does it take to trigger?

Tracking new procedures SCTS in conjunction with British Cardiac Interventional Society All TAVIs since introduction in UK Agreed dataset Data validated Long term mortality tracking In conjunction with (and funded by) commissioners of healthcare

Improving the reputation of cardiac surgery

Increasing profile and Influence of professional society Maintaining Patients launched by the Right Honourable Andrew Lansley, Secretary of State for Health at the SCTS annual meeting in March 2011 NHS paper June 08 Policy Paper A5 NHS Improvement plan Houses of Parliament, Early Day Motion is-falling.htmlhttp:// is-falling.html Europe-report.htmlhttp:// Europe-report.html bypass-survival-rates /, bypass-survival-rates /

Research substrate Methods of risk stratification –Validating existing models –Developing new models Clinical Hypothesis testing –BIMA vs SIMA clinical outcomes –On-pump vs Off pump surgery –Late outcomes depending on prosthesis choice Health service research –Volume outcomes association

Supporting shared decision making for patients Improving overall quality Advancing knowledge Improving the reputation of cardiac surgery Increasing the profile and influence of the professional society Benefits

Thanks for listening Any questions?