26 th january
DESCRIPTION
26 th January. SESSION XIV – DEBATE DGH vs Tertiary intervention – Is there really a conflict? Department of Health Perspective Roger Boyle. No conflict of interest to declare. Cardiac surgeons. Tertiary centre cardiologist. DGH cardiologist. Cardiology in the district hospital. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/1.jpg)
26th January
SESSION XIV – DEBATE
DGH vs Tertiary intervention –
Is there really a conflict?
Department of Health Perspective
Roger Boyle
![Page 2: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/2.jpg)
No conflict of interest to declare
![Page 3: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/3.jpg)
DGH cardiologist Tertiary centre cardiologist
Cardiac surgeons
![Page 4: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/4.jpg)
Cardiology in the district hospital.Report of a working group of the British Cardiac SocietyBr Heart J. 1987; 537-546
“The district cardiologist may wish to maintain skills by participating in catheter sessions….”
A report of a working group of the British CardiacSociety: cardiology in the district hospital.Br Heart J. 1994; 72: 303-308
“It is becoming commonplace for district hospitals to develop their owncatheterisation facilities…………..”
![Page 5: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/5.jpg)
BCS Council Meeting circa 1994
![Page 6: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/6.jpg)
Statement by the Council of the British CardiacSociety. Strategic planning for cardiac servicesand the internal market: role of catheterisationlaboratories in district general hospitals.Br Heart J. 1994; 71: 110-112
DGH cardiologists should be offered specific sessions in tertiary labs
Some DGHs that are geographically disadvantaged might developtheir own labs
Over time, DGH labs would become the norm!!!!!!!!!
![Page 7: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/7.jpg)
BCS Working Group:The changing interface between district hospitalcardiology and the major cardiac centresHeart 1997; 78: 519-523
![Page 8: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/8.jpg)
Main conclusions
• The establishment of new cardiac catheterisation laboratories in DGHs remote from a major centre should be encouraged provided the workload is adequate to ensure efficient use of the facility
• Cardiologists working in districts close to a major centre should be encouraged to catheterise their patients at the centre
![Page 9: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/9.jpg)
UK Centres - 2005
52 52 53 54 54 5358 61 63 66 64 64
738377
87
6568
83
0
20
40
60
80
10019
91
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
No.Centres
PCI Angio only
2005 data: Ludman
![Page 10: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/10.jpg)
England - Revascularisation - Numbers - CABG & PCI 1999/2000-2004/05 (Source: DH Returns)
0
10000
20000
30000
40000
50000
60000
70000
80000
1999-2000 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005estimate
CABG
PCI
Total
![Page 11: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/11.jpg)
Revascularisation trends
Rate per million in England
0
200
400
600
800
1000
1200
1400
1600
1989
/90
1990
/91
1991
/92
1992
/93
1993
/94
1994
/95
1995
/96
1996
/97
1997
/98
1998
/99
1999
/00
2000
/01
2001
/02
2002
/03
2003
/04
2004
/05
2005
/06
CABG
PCI
Total
![Page 12: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/12.jpg)
Angiography waiters from April 2005
0
5,000
10,000
15,000
20,000
25,000
April
May
June Ju
ly
Augus
t
Septe
mbe
r
Octob
er
Novem
ber
Decem
ber
Janu
ary
Febru
ary
Mar
chApr
ilM
ayJu
ne July
Augus
t
Septe
mbe
r
Octob
er
Novem
ber
9+
08-Sep
07-Aug
06-Jul
05-Jun
04-May
03-Apr
02-Mar
01-Feb
0-1
![Page 13: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/13.jpg)
PCI waiters by length of wait April 2002 onwards
0
1,000
2,000
3,000
4,000
5,000
6,000
Apr Jul
OctJa
nApr Ju
lOct
Jan
Apr Jul
OctJa
nApr Ju
lOct
Jan
Apr Jul
Oct
9 to 12
6 to 9
3 to 5
0 to 3
2002/3 2003/4 2004/5 2005/6 2006/7
![Page 14: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/14.jpg)
Southampton – November 2006
![Page 15: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/15.jpg)
SEPHO Revascularisation Model - Version 5 - Rates pmp
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Rate pmp 2003/4
Rate pmp 2015 Model
1900 pmp
2200 pmp
2500 pmp
![Page 16: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/16.jpg)
83
87
PCI centres
Angiography onlyCentres
2005
![Page 17: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/17.jpg)
![Page 18: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/18.jpg)
‘A discussion of the drugs administered in a case of coronary thrombosis is not relevant here – but for pain relief morphine is often given by an attending doctor or on arrival at hospital….the patient should not be questioned unduly or in any way alarmed.’
1970
![Page 19: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/19.jpg)
Heart Attack: Progress Since the NSF
• Percentage of patients treated within 30 minutes of arrival at hospital rose from 38% to 83%
• Paramedics trained to assess, diagnose and provide thrombolysis
• Percentage of patients treated within 60 minutes of a call for help rose from 30% to 65%
• Pilot schemes set up to test feasibility of primary angioplasty in the NHS
![Page 20: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/20.jpg)
Reperfusion treatment 2003-6
0
10
20
30
40
50
60
70
80
90
100
2003 2004 2005 2006
In hospital lysis
Prehospital lysis
PPCI
12.6%
14.4%
%
[plus patients in NIAP not yet transferred~ 2.5%]
![Page 21: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/21.jpg)
Access to PPCI
• 37/68 English & Welsh hospitals with interventional facilities on site perform primary angioplasty
• 14/37 provide an internal service only– Only 4 provide 24/7, the rest lab hours or ‘occasional’
• 23/37 offered a service to other hospitals– Reporting that they provided this to 78 hospitals
– NB only 42 non interventional hospitals said they received a routine PPCI service, suggesting that service to other hospitals might be irregular / occasional
![Page 22: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/22.jpg)
James Cook - Friarage
Leeds- SJUH- Bradford
East London- R London- Whipps X- King George- Oldchurch- Homerton- Newham
Leeds- SJUH- Bradford
SE London-Lewisham-Bromley-Sidcup-Mayday
Manchester (2)-North Mcr-Salford-Stockport-Tameside-Trafford
NW London (3)-Hammersmith-W Middlesex-Ealing-Charing X-St Mary’s-Northwick-Hillingdon-Harefield-Brompton-Hemel
Exeter
![Page 23: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/23.jpg)
Trust Catchment Areas
Secondary - Acute MI Tertiary - CABG
No. of Trusts 153 28
Ave Pop Served 321,000 1.7 million
Largest 787,000 3.2 million
Smallest 104,000 816,000
Acute MI Catchments Tertiary CABG Catchments
![Page 24: 26 th January](https://reader035.vdocuments.net/reader035/viewer/2022062315/56814e4a550346895dbbd408/html5/thumbnails/24.jpg)
Conclusion
• District hospital angiography has improved access to care and the capacity is needed
• Still a great deal of unmet need particularly in the North• We are a long way from providing a comprehensive
PPCI service at the present• Many places are ‘dabbling’• We need a comprehensive strategy within each network
with formal involvement of the ambulance service• No reason to exclude DGHs from providing this but the
rota requirements are onerous