BCIS Audit Returns of Interventional Procedures 2000 Mark de Belder BCIS UK National Audit Officer on behalf of Council of the British Cardiovascular Intervention Society Southampton, October 2001

UK Intervention Centres

UK Interventional & Diagnostic Centres caths for every 1 PCI in Intervention centres (1.2-82) (3.51 NHS, 3.73 Private) Making assumptions about no. of caths done in centres not reporting, estimated caths in UK approx 145,000 = 4.3 caths/PCI

Centres providing NO DATA n None!

Centres providing NO or MINIMAL data on Centre Description Form (A) n Harefield n Edinburgh Royal Infirmary n Sheffield n (Ayrshire & Arran) n Cromwell n Bristol BUPA

Centres providing NO or MINIMAL DATA on Minimum Data Form (B) n No data n Harefield n BUPA Bristol n Minimal Data n Birmingham QEH n Yorkshire Ht Centre n Sheffield

Centres with MINIMAL or NO DATA on Outcome Form (C) n Belfast City n City, Birmingham n Harefield n Yorkshire Heart Centre n UH Wales, Cardiff n London Chest n Manchester RI n John Radcliffe, Oxford n Royal Brompton n Northern, Sheffield n St Bartholomew’s n St Mary’s n Derriford, Plymouth n Eastbourne n Wellington n Ross Hall n London Independent n St Anthony’s n The Priory, Birmingham n Harley St Clinic n BUPA Bristol n BUPA Lea Cambridge

Centres with no HOSPITAL Outcome Data n Cath Lab Data Only n Blackpool n Edinburgh Western n Wythenshawe n Morriston, Swansea n BMI Alexander, Manchester n BUPA Leicester n HCI Glasgow n Unspecified Data n Belfast Royal Victoria n Birmingham QE n Bristol Royal Infirmary n Hammersmith n Hull Royal Infirmary n Papworth n Edinburgh Royal Infirmary n Glasgow Western n Glasgow Royal Infirmary n Liverpool CTC n Middlesex/UCH n Freeman, Newcastle n Glenfield, Leicester n Hairmyres n Unspecified Data n BUPA Leeds n London Bridge n Cromwell n Yorkshire Heart Clinic n Park, Nottingham

Volume of procedures in NHS Centres Total number of procedures per annum

Total UK PCI Procedures

PCI Rates per million population (UK)

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

PCI: UK vs Rest of Europe 1996/1998

No. of Consultant Interventionists in NHS Centres, 2000 data from 48 centres Average 5.5 / Centre

No of PCIs per Consultant in NHS Centres, 2000 data from 48 centres Average 125 / Consultant

All PCI Procedures Mortality 2000 data from 48 centres

All PCI procedures 2000 data from 41 centres

Stent procedures data from 61 centres

Stenting in different centres data from 61 centres

Impact of Stenting data from 40 centres

Stenting and the need for emergency CABG (2000 data from 40 centres)

Stenting and procedures for restenosis (2000 data from 40 centres)

PCI for Restenosis (2000 data from 40 centres)

Stent Procedures data from 29 centres

Stent use (2000 data from 29 centres)

ReoPro in different centres data from 61 centres ReoPro used in 22% of cases in cases using eptifibatide or tirofiban reported

ReoPro use data from 61 centres

Other procedures , =, - : increase, no change or decrease compared to 1999 * mainly Xsizer NB Only 2 reported to voluntary registry

Other procedures , =, - : increase, no change, or decrease compared to 1999 * Mainly Angioseal

Other Procedures , =, - : increase, no change, or decrease compared to 1999

Other Procedures , =, - : increase, no change or decrease compared to 1999 * Some centres give combined data for ASD/PFO closure

Other Procedures , =, - : increase, no change, or decrease compared to 1999

Other procedures , =, - : increase, no change, or decrease compared to 1999

Centres providing complete or near complete data on Hospital Outcome 2000 (18) n Aberdeen n Birmingham Heartlands n Guy’s & St Thomas’s n King’s College Hospital n Walsgrave, Coventry n Royal Free Hospital n Stoke City General n Southampton n St George’s n James Cook UH, Middlesbrough n Nottingham City Hospital n Royal Devon & Exeter n KE VIIth, Midhurst n Sandwell Hospital n Royal Sussex County, Brighton n Ayrshire & Arran n RCH Truro n Heart Hospital

Hospital Outcome 2000 All patients Data from 18 centres

Hospital Outcome Death (with 95% CI) Data from 18 centres

Hospital Outcome Freedom from MACE rates (with 95% CI) Data from 18 centres

Hospital Outcome Em. CABG (with 95% CI) Data from 17 centres

Hospital Outcome Failed Procedures (with 95% CI) Data from 18 centres

Examples of different case-mix

Hospital Outcome 2000 Elective patients * does not account for clinical syndrome

Hospital Outcome 2000 Patients with previous CABG and those treated for restenosis * does not account for clinical syndrome

Hospital Outcome 2000 Unstable angina

Hospital Outcome 2000 Acute closure

Hospital Outcome 2000 Acute MI patients

Hospital Outcome 2000 Post MI patients

Hospital Outcome Elective Single Vessel PCI (no CTO) Success (Freedom from MACE) rates (with 95% CI) Data from 15 centres

Hospital Outcome Elective Single Vessel PCI (no CTO) Mortality rates (with 95% CI) Data from 15 centres

Hospital Outcome Cardiogenic Shock PCI (Primary or Rescue) Mortality rates (with 95% CI) Data from 15 centres 1 of 1

Comparison of data reported from a single centre with other contributing centres

BCIS/CCAD Update CCAD n Questionnaire n DoH Meeting, November 2001 n NHSIA Meeting to revisit datasets n Phased participation over 2002? n Pressure on Trusts/Commissioners

BCIS/CCAD Update Data Set Parallel Projects n A = Centre n B = Bean Count n C = Outcome data by Syndrome

BCIS New Technologies Group - Registries n Brachytherapy n Endicor X-sizer

BCIS/CCAD Update Conclusions n Continued growth in PTCA (84% stented, % with GP IIb/IIIa) but still lagging behind European/American centres n Still a lot of low volume operators n Expansion of PCI activity appears to have been achieved in 2 ways –higher numbers of PCIs performed in a small number of hands –increased numbers of operators (presumably attending consultants from other hospitals)

BCIS/CCAD Update Conclusions n Data submission still incomplete - questionnaire to establish what is needed. n Encouraging noises from DoH re CCAD n BCIS will continue current data collection system even for those units who start to use CCAD n Current system provides some means of bench- marking n New Technologies Registries may not be effective on a voluntary basis (CCAD could overcome this)

Clinical Governance Individual outcomes ‘to be public within a year’ Hospital Doctor 18th October 2001 “DoH considering a proposal from Dr Foster”