Consistency in diagnostic and treatment procedures Specifically angiography and angioplasty Dr Alison Round 14 October 2015.

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Presentation transcript:

Consistency in diagnostic and treatment procedures Specifically angiography and angioplasty Dr Alison Round 14 October 2015

How the comparators were chosen A composite of variables: 3 relate to proportion of young people in the population, 2 to measures of ethnicity, 2 to measures of deprivation and health outcomes, 2 to measures of population density, 1 each to proportion of elderly, mobility of population and total population. Standardised differences between variables added together to find an overall minimal difference There is no perfect way to do this.

Demographics of comparators CCG Early CVD (<75) mortality (rank) Early stroke (<75) mortality (rank) Late stroke (>75) mortality (rank) % population living in the most deprived 5th national wards (rank) % population over 75 NEW Devon 38.6 (8) 11.6 (6) 641.6 (8) 11.3 (8) 9.6 (7) Gloucestershire 40.3 (9) 12.7 (8) 634.7 (7) 7.2 (4) 7.6 (5=) Kernow 36.9 (50) 14.7 (10) 855.7 (10) 9.8 (7) 7.2 (3=) Dorset 30.4 (3) 12.4 (7) 617.4 (6) 7.8 (5) 11.3 (10) Somerset 35.5 (4) 13.0 (9) 659.0 (9) 3.7 (2) 10.0 (9) Oxfordshire 29.8 (2) 10.9 (3) 572.0 (3) 5.5 (3) 7.2 (3) Cambridge and Peterborough 38.4 (7) 7.9 (2) 574.9 (4) 9.4 (6) 7.1 (2) Nene 37.2 (6) 11.3 (4=) 517.2 (1) 11.8 (9) 6.8 (1) West Hampshire 28.6 (1) 7.2 (1) 576.6 (5) <1 (1) 9.8 (8) Southern Derbyshire 53.4 (10) 540.1 (2) 16.5 (10)

Directly standardised rates / 100,000 pop. Procedure NEW Devon Lowest comparator Highest comparator England average Angiography male 480 273 597 448 Angiography female 252 139 364 239 Angioplasty male 223 174 390 220 Angioplasty female 76 51 123 72 CABG male 86 28 94 64 CABG female 21 7 15

Why we might consider doing less NICE guidance on recent onset chest pain CG95 The extent to which bypass surgery confers incremental prognostic benefit in people with three vessel or left main stem disease who are also treated with contemporary secondary prevention therapies (antiplatelet agents, statins, renin-angiotensin system inhibitors) is uncertain Medical treatment is more cost-effective than early revascularisation with either CABG or PCI in people with stable coronary artery disease including people with type 2 diabetes mellitus. However if symptoms are not controlled, revascularisation is effective and could be cost-effective.

Why we might consider doing less Offer coronary angiography to guide treatment strategy for people with stable angina whose symptoms are not satisfactorily controlled with optimal medical treatment. All people with stable angina should be offered appropriate medical therapy, but if symptoms are not controlled they should be considered for myocardial revascularisation NICE guidance on chronic heart failure CG108 Coronary revascularisation should not be routinely considered in patients with heart failure due to systolic left ventricular impairment, unless they have refractory angina.