bcis audit returns of interventional procedures 1999
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BCIS Audit Returns of Interventional Procedures 1999. Blackpool, October 2000 Mark de Belder (Audit Secretary, BCIS) on behalf of Council of the British Cardiovascular Intervention Society. UK Intervention Centres. UK Interventional & Diagnostic Centres 1999. - PowerPoint PPT PresentationTRANSCRIPT
BCIS Returns 1999 (Oct 2000)
BCIS Audit Returns of BCIS Audit Returns of Interventional ProceduresInterventional Procedures
19991999
Blackpool, October 2000
Mark de Belder
(Audit Secretary, BCIS)
on behalf of Council of the British Cardiovascular Intervention Society
BCIS Returns 1999 (Oct 2000)
UK Intervention CentresUK Intervention CentresYear No. Centres1991 521992 521993 531994 541995 541996 531997 581998 611999 63
BCIS Returns 1999 (Oct 2000)
UK Interventional & Diagnostic UK Interventional & Diagnostic Centres 1999Centres 1999
No. No Data(%)
Caths(% oftotal)
PCIs*(% oftotal)
NHSInterventional
48 13(27%)
72,133(68%)
19,276(92%)
PrivateInterventional
15 4(27%)
7449(7.9%)
1678(8%)
Diagnosticonly
71 23(32%)
23,273(24%)
0
TOTAL 134 - 102,855 20,954
3.8 caths for every 1 PCI in Intervention centres (1.5-21)4.1 caths for every PCI overall assuming other diagnostic centres = 485/yr
* No of PCIs in Centres also reporting No of Caths
BCIS Returns 1999 (Oct 2000)
Centres providing NO DATACentres providing NO DATA
St Bartholomew’s
BCIS Returns 1999 (Oct 2000)
Centres providing NO DATACentres providing NO DATAon Centre Description Form (A)on Centre Description Form (A)
Harefield Edinburgh Royal Infirmary The Royal Infirmary, Glasgow Freeman Hospital, Newcastle St Bartholomew’s (Ayrshire & Arran) HCI Glasgow Bristol BUPA
BCIS Returns 1999 (Oct 2000)
Centres providing Centres providing NO OR MINIMAL DATANO OR MINIMAL DATA
on Minimum Data Form (B)on Minimum Data Form (B)No data Harefield St Bartholomew’s
Minimal Data Guy’s/St Thomas’s London Chest (Ayrshire & Arran) HCI Glasgow Bristol BUPA
BCIS Returns 1999 (Oct 2000)
Centres with Centres with MINIMAL OR NO DATAMINIMAL OR NO DATAon Outcome Form (C)on Outcome Form (C)
Guy’s & St Thomas’sHarefieldLondon ChestSouthamptonSt Bartholomew’s
BCIS Returns 1999 (Oct 2000)
Centres with no Centres with no HOSPITALHOSPITAL Outcome Data Outcome Data
Cath Lab Data Only Aberdeen Yorkshire Heart Centre Glasgow Western Infirmary Glasgow Royal Infirmary Manchester Royal Infirmary St Mary’s Hairmyres Morriston, Swansea BMI Alexander, Manchester London Bridge Hospital BUPA Leicester Cromwell St Anthony’s The Priory, Birmingham HCI, Glasgow Harley Street Clinic
Unspecified Data Belfast City Belfast Royal Victoria Birmingham City Hospital Birmingham QE Blackpool Hammersmith Cardiff Walsgrave Hospital, Coventry Edinburgh Royal Infirmary London Chest Wythenshawe, Manchester Middlesex Hospital Freeman, Newcastle John Radcliffe, Oxford Royal Brompton Glenfield, Leicester Northern General, Sheffield Plymouth Derriford Eastbourne
Unspecified DataWellingtonBUPA LeedsRoss Hall IndependentLondon IndependentBUPA BristolHeart Hospital
BCIS Returns 1999 (Oct 2000)
Volume of procedures in NHS CentresVolume of procedures in NHS CentresTotal number of procedures per annumTotal number of procedures per annum
0123456789
<10
0
-200
-300
-400
-500
-600
-700
-800
-900
-100
0
>10
00
1997
1998
1999
(assumes St Bartholomew’s performedsimilar numbers of PCIs as in 1997)
BCIS Returns 1999 (Oct 2000)
Total UK PCI ProceduresTotal UK PCI ProceduresYear Centres Total
ProceduresRate permillion
%increase
1991 52 9,933 174
1992 52 11,575 203 16.5
1993 53 12,937 227 11.8
1994 54 14,624 256 13.0
1995 54 17,344 304 18.6
1996 53 20,511 359 18.1
1997 58 22,902 402 11.7
1998 61 24,899 437 8.7
1999 63 28,133 494 13
Assumes St Bartholomew’s activity = 1997
BCIS Returns 1999 (Oct 2000)
PCI Rates per million population PCI Rates per million population (UK)(UK)
050
100150
200250
300350
400450500
'85
'88
'90
'92
'94
'96
'98
BCIS Returns 1999 (Oct 2000)
PCI: UK 1996-1999 PCI: UK 1996-1999 vs Rest of Europe 1996/1998vs Rest of Europe 1996/1998
0200400600800
100012001400160018002000
PCIs/million
Po
r
Ita
UK
96
UK
97
UK
98
UK
99
Sp
a
Fin
Gre
De
n
Sw
e
No
r
Au
st
Ne
th
Fra
Sw
i
Be
lg
Ge
r
1996
1998
BCIS Returns 1999 (Oct 2000)
All PCI Procedures MortalityAll PCI Procedures MortalityYear Data From: Total Mortality % Range %
1991 9,071(9,933)
0.48
1992 43/52 10,483(11,575)
0.71 0-3.5
1993 44/53 11,859(12,937)
0.59 0-2.7
1994 44/54 12,598(14,624)
0.60 0-2.7
1995 35/54 11,365(17,344)
0.69 0-3.4
1996 37/53 14,476(20,511)
0.72 0-3.2
1997 41/58 17,577(22,902)
0.91 0-10
1998 44/61 16,946(24,899)
0.80 0-9.1
1999 48/63 20,975(28,133)
0.61 0-4
BCIS Returns 1999 (Oct 2000)
All PCI proceduresAll PCI proceduresYear Total Vessels/
caseSuccess
%MI % Em.
CABGMortality
%1991 9,933 86 1.6 2.6 0.48
1992 11,575 1.17 88 1.4 2.0 0.71
1993 12,937 1.09 89 1.1 1.9 0.59
1994 14,624 1.15 90 1.0 1.6 0.60
1995 17,344 1.17 89 1.4 1.9 0.69
1996 20,511 1.17 90 1.4 1.7 0.72
1997 15,667(22,902)
1.16 92 1.2 1.1 0.89
1998 18,560(24,899)
1.24 92 0.8 0.7 0.80
1999 19,889(28,133)
1.11 90 0.57 0.48 0.61
BCIS Returns 1999 (Oct 2000)
Stent proceduresStent procedures
0
10
20
30
40
50
60
70
80
% of all PCIs
'92 '93 '94 '95 '96 '97 '98 '99
Year
BCIS Returns 1999 (Oct 2000)
Stenting in different centres Stenting in different centres 19991999
02468
1012141618
No. of Centres
31-40 41-50 51-60 61-70 71-80 81-90 >90
% Stented
1998
1999
BCIS Returns 1999 (Oct 2000)
Impact of Stenting 1992-1999Impact of Stenting 1992-1999Year % Stented % PCI for
Restenosis% needingEm.CABG
1992 2.7 11.6 2.0
1993 5.6 12.3 2.0
1994 13.5 11.4 1.8
1995 27.6 9.6 1.9
1996 45.9 9.4 1.5
1997 60 7.4 1.1
1998 69 5.2 0.6
1999 79 4.8 0.48
BCIS Returns 1999 (Oct 2000)
Stenting and the need for Stenting and the need for emergency CABG emergency CABG (1999 data from 46 centres)(1999 data from 46 centres)
0
10
20
30
40
50
60
70
80
90
'92 '93 '94 '95 '96 '97 '98 '99
Year
%
0
0.5
1
1.5
2
2.5
%
% Stent
% Em.CABG
BCIS Returns 1999 (Oct 2000)
Stenting and procedures for Stenting and procedures for restenosis restenosis
(1999 data from 32 centres)(1999 data from 32 centres)
0
10
20
30
40
50
60
70
80
90
'92 '93 '94 '95 '96 '97 '98 '99
Year
%
0
2
4
6
8
10
12
14
%
% Stent
% Restenosis
BCIS Returns 1999 (Oct 2000)
PTCA for Restenosis 1999PTCA for Restenosis 1999(data from 31 centres)(data from 31 centres)
0
2
4
6
8
10
12
14
16
No. of Centres
0-5 5.1-10 10.1-15
% for Restenosis
1998
1999
BCIS Returns 1999 (Oct 2000)
Stent Procedures 1999Stent Procedures 19991992 1993 1994 1995 1996 1997 1998 1999
Elective 179 341 834 2,595 2,373 3,170(45%)
(7.5-100)
3,376(56%)(0-100)
7,244(64%)
(19-100)
Sub-optimal 2,166 2,759(39%)(0-98)
2,238(37%)(0-100)
3,909(31%)(0-83)
Bail-out 140 286 1,086 1,269 429 975(14%)(0-52)
410(6.8%)(0-27)
538 (4.8%)(0-35)
% Bail-out 44 46 44 33 16 14 6.8 4.8
Total StentProcedures
319 660 1,937 4,574 9,165 7,096of
11,905
6,024of
12,507
11,691of
19,769
BCIS Returns 1999 (Oct 2000)
ReoPro in different centres ReoPro in different centres 19991999
0
2
4
6
8
10
12
14
No. of Centres
0_5
6_10
11_1
5
16_2
0
21_2
5
26_3
0
31-3
5
36_4
0
41_4
5
% ReoPro
ReoPro used in 11% of cases overall (3pts Aggrastat)
BCIS Returns 1999 (Oct 2000)
Other procedures 1999 - 1Other procedures 1999 - 1
PTCRA DCA TEC Laser CB Thromb
Centres 13-
5-
4-
2=
26+
8+
No. 114-
23-
5-
7-
313++
16+
Mean 8.8-
4.6=
1.24-
3.5 12 2+
Range 1-36 -
1-8 -
1-2 -
1-6 1-72 +
-1-5 +
+, =, - : increase, no change or decrease compared to 1998
BCIS Returns 1999 (Oct 2000)
Other procedures 1999 - 2Other procedures 1999 - 2
BrachyRx P(D)MR IVUS Groinclosure
Centres 1=
2+
30++
31+
Number 4-
9+
421-
3145++
Mean - 4.5+
14-
101+
Range - 2-7 +
1-56 -
1-418 -
+, =, - : increase, no change, or decrease compared to 1998
BCIS Returns 1999 (Oct 2000)
Other Procedures 1999 - 3Other Procedures 1999 - 3
MVplasty AVplasty PVplasty TVPlasty Coart/Re-coarct
Centres 31+
8+
11+
1-
3-
No. 254+
15+
15+
1-
3-
Mean 8.2+
1.9+
1.4-
- 1
Range 1-31 -
1-5 +
1-3 -
- 1
+, =, - : increase, no change, or decrease compared to 1998
BCIS Returns 1999 (Oct 2000)
Other Procedures 1999 - 4Other Procedures 1999 - 4PDA ASD* PFO* VSD
Centres 4+
19+
2=
0-
No. 6=
105+
5=
0-
Mean 1.5-
5.5=
2.5=
-
Range 1-3 =
1-13 -
1-4 +
-
+, =, - : increase, no change or decrease compared to 1998* Some centres give combined data for ASD/PFO closure
BCIS Returns 1999 (Oct 2000)
Other Procedures 1999 - 5Other Procedures 1999 - 5
Renal Sub-clavian
Pulm.artery
Aorta SVC Carotid
Centres 1=
1=
1=
1=
2+
0
No. 4=
1=
2+
1=
4+
0
Mean - - - - 2 -
Range - - - - 1-3 -
+, =, - : increase, no change, or decrease compared to 1998
BCIS Returns 1999 (Oct 2000)
Other procedures 1999 - 6Other procedures 1999 - 6FB
removalEmboln. Pericard. Pressure
WireAngio-Guard
SeptalAbln.
MustardBaffle PTA
Centres 7-
4--
1 2 1 1 0
Number 11-
14-
3+
44 5 1 0
Mean 1.6-
3.5+
- 22 -
Range 1-3 -
1-4 +
- 22 -
+, =, - : increase, no change, or decrease compared to 1998
BCIS Returns 1999 (Oct 2000)
Centres providing complete or Centres providing complete or near complete data onnear complete data on
Hospital Outcome 1999 (16-) Hospital Outcome 1999 (16-)
Birmingham Heartlands Bristol Royal Infirmary Hull Royal Infirmary King’s College Hospital Papworth Edinburgh Western General Liverpool CTC Royal Free Hospital Stoke City General
South Cleveland Hospital Nottingham City Hospital Royal Devon & Exeter KE VIIth, Midhurst Sandwell Hospital Royal Sussex County, Brighton
Yorkshire Clinic, Bradford
BCIS Returns 1999 (Oct 2000)
HospitalHospital Outcome 1999 Outcome 1999Elective patientsElective patients
No.(centres)
Success PartialSuccess
RepeatPCI
CABG MI Death(Range)
StableSingle Ves(no CTO)
2924(16)
94% (83-100)
0.8% (0-4.2)
0.4%(0-1.9)
0.5%(0-1.9)
0.3%(0-0.9)
0.2%(0-0.8)
StableMultivessel(no CTO)
738(16)
91%(63-100)
6.2%(0-38)
0.5%(0-2.6)
0.5%(0-15)
0.4%(0-1.8)
0.4%(0-3.3)
Single VesCTO *
479(16)
69%(50-97)
2.1%(0-15)
0.4%(0-6.9)
0.4%(0-7.7)
0.4%(0-2.3)
0%
MultivesselInc. CTO *
407(16)
85%(33-100)
11%(0-67)
0.7%(0-6.3)
0% 0.2%(0-3.1)
0.2%(0-0.6)
* does not account for clinical syndrome
BCIS Returns 1999 (Oct 2000)
HospitalHospital Outcome 1999 Outcome 1999Elective patientsElective patients
No.(centres)
Success PartialSuccess
RepeatPCI
CABG MI Death(Range)
CABG pts * 573(16)
93%(50-100)
1.2%(0-50)
0.5%(0-3.1)
0.2%(0-1)
0.2%(0-2.9)
0.3%(0-3.1)
Restenosis * 276(16)
95%(88-100)
1.1%(0-3)
0% 0% 0.4%(0-2.4)
0.4%(0-5.3)
* does not account for clinical syndrome
BCIS Returns 1999 (Oct 2000)
HospitalHospital Outcome 1999 Outcome 1999Unstable anginaUnstable angina
No.(Centres)
Success PartialSuccess
RepeatPCI
CABG Q MI Death(Range)
Single VesUA
1708(16)
94%(67-100)
0.8%(0-7)
0.6%(0-2)
0.4%(0-11)
0.6%(0-1.6)
0.4%(0-1.9)
MultivesselUA
348(16)
89%(75-100)
8.9%(0-25)
0.6%(0-5.6)
0.6%(0-13)
0.3%(0-5.6)
0.3%(0-2.8)
BCIS Returns 1999 (Oct 2000)
HospitalHospital Outcome 1999 Outcome 1999Acute closureAcute closure
No.(Centres)
Success PartialSuccess
RepeatPCI
CABG Q MI Death(Range)
Acuteclosure
50(15)
64%(0-90)
2%(0-33)
0% 4%(0-33)
6.0%(0-100)
10%(0-33)
BCIS Returns 1999 (Oct 2000)
HospitalHospital Outcome 1999 Outcome 1999Acute MI patientsAcute MI patients
No.(Centres)
Success PartialSuccess
RepeatPCI
CABG re-MI Death(Range)
PrimaryPTCA
145(12)
92%(83-100)
3.4 %(0-9.1)
0.7%(0-6.3)
0.7%(0-4.5)
4.8%(0-100)
3.4%(0-17)
SalvagePTCA
183(13)
79%(69-100)
1.1%(0-5.3)
1.6%(0-5.6)
0.5%(0-1.3)
4.4%(0-100)
7.1%(0-15)
Re-MIPTCA
43(3)
98%(97-100)
0% 0% 0% 2.3%(0-3.2)
0%
Shock 183(12)
36%(0-75)
2.9%(0-33)
1.4%(0-17)
2.9%(0-33)
10%(0-100)
47%(0-100)
BCIS Returns 1999 (Oct 2000)
HospitalHospital Outcome 1999 Outcome 1999Post MI patientsPost MI patients
No.(Centres)
Success PartialSuccess
RepeatPCI
CABG Re-MI
Death(Range)
Post MI UA 457(10)
96%(88-100)
0.3%(0-6.3)
0.9%(0-3.2)
0.7%(0-2.8)
0.9%(0-3.2)
0.7%(0-6.3)
Post MIStable/+ETT
413(9)
89%(86-100)
1.2%(0-4.4)
0.7%(0-5.3)
0% 0.2%(0-1.1)
0%
ALL MIPatients
864(15)
87%(67-100)
6.5%(0-17)
0.9%(0-5.9)
0.6%(0-2.1)
1.3%(0-17)
5.9%(0-17)
BCIS Returns 1999 (Oct 2000)
Potential for comparison of your own Potential for comparison of your own centre with the benchmarkscentre with the benchmarks
0 1 2 3 4 5
In-hospital mortality for elective 1V, non CTO lesion
BCIS Returns 1999 (Oct 2000)
Potential for comparison of your own Potential for comparison of your own centre with the benchmarkscentre with the benchmarks
0 20 40 60 80 100
In-hospital mortality for cardiogenic shock
BCIS Returns 1999 (Oct 2000)
BCIS/CCAD UpdateBCIS/CCAD UpdateCCADCCAD
Pilot ProjectDoH decision IT systems (NHS + Trusts)NSF/Clinical Governance
BCIS Returns 1999 (Oct 2000)
BCIS/CCAD UpdateBCIS/CCAD UpdateData SetData Set
A = Centre B = Bean Count C = Outcome data by Syndrome
BCIS Returns 1999 (Oct 2000)
BCIS New Technologies BCIS New Technologies Group - RegistriesGroup - Registries
BrachytherapyEndicor X-sizer
BCIS Returns 1999 (Oct 2000)
BCIS/CCAD UpdateBCIS/CCAD UpdateConclusionsConclusions
Continued growth in PTCA (79% stented) but still far behind European/American centres
Data collection still disappointing in many centres - further efforts to achieve compliance
Departments must sort out IT and Audit requirements Database compatibility with BCIS/CCAD still
essential Current analysis by Syndrome can provide “Bench-
marks” New Technologies Registries will help, not hinder