BCIS Audit Returns Adult Interventional Procedures Jan 2008 to Dec 2008 Peter F Ludman BCIS National Audit Lead On behalf of British Cardiovascular Intervention Society Bournemouth October 2009 Contents 2008 data: Ludman • Structure – Multi-vessel treatment – New centres – Additional interventional techniques – Total PCI numbers – Arterial access – No of procedures per unit • complications – PCI pmp and by country • DTB times – PCI Operators • Process of care – Surgical cover – Delays to treatment NSTEMI – Day case activity – Delays to treatment Primary PCI – Primary PCI units • DTB times by unit • PCI Procedure specific data • CTB times by unit – CCAD data completeness • Non coronary intervention – Demographics – HOCM septal ablation – Ethnicity – Mitral valuloplasty • Appropriateness – Other adult structural intervention – indication for PCI / Clinical syndrome – Transcutaneous Aortic Valves – Circadian activity for PPCI • Outcome – Stents (BMS and DES) – MACCE – Adjunctive therapy – Outcome by syndrome – LV support – Outcome by lesion subset – Shock – Risk adjusted outcomes Structure 2007 data: Ludman Angiography Centres 2008 New Centres 2008 data: Ludman Maidstone (restarts) Peterborough District Hospital West Suffolk Hospital Ipswich Hospital Centres ceasing activity St James’s University Hospital Western General (Bristol) Bristol Spire Droitwich Spa PCI Centres 2008 2008 data: Ludman PCI becomes Angio only Southend PCI Centres 2008 New PCI Centres 2008 data: Ludman Frenchay Hospital (Bristol) Kettering General Hospital PCI centres from existing angiography units Kent and Sussex Hospital Darrent Valley Kings Mill Hospital (Mansfield) Lincoln County Hospital Worcester Royal Hospital No. of Centres 100 120 20 40 60 80 0 1991 1992 UK Centres 2008 1993 1994 1995 1996 1997 PCI 1998 1999 2000 Angio only 2001 2002 2003 2004 91 2005 90 2006 98 85 2007 105 2008 81 2008 data: Ludman 2008 Angiography (81) PCI (105) PCI Centres in 2008 UK Countries 2008 data: Ludman Scotland NHS 7→5 Private 1 England NHS 76 Private 16 N Ireland 3 Wales 2 Total 105 PCI Data Sources 2008 data: Ludman All UK England Wales Angio Only Aggregate PCI Audit form Audit form partial Northern Ireland Scotland (via MINERVA upload) CCAD UK Interventional and Diagnostic centres 2008 2008 data: Ludman No. No No Caths PCIs cath PCI (% of total) (% of total) data data NHS 88 0 0 Interventional Private 17 1 1 Interventional Diagnostic 81 2 na only TOTAL 186 Aggregate forms UK Interventional and Diagnostic centres 2008 2008 data: Ludman No PCINo. data:No No Caths PCIs cath PCI (% of total) (% of total) London dataIndependentdata Hospital NHS 88 0 0 Interventional Private 17 1 1 Interventional Diagnostic 81 2 na only TOTAL 186 Aggregate forms UK Interventional and Diagnostic centres 2008 2008 data: Ludman No angiographyNo. No Nodata: Caths PCIs University Hospitalcath PCI of(% Hartlepool of total) (% of total) Princess ofdata Walesdata Hospital, Bridgend NHS 88 0 0 Interventional Private 17 1 1 Interventional Diagnostic 81 2 na only TOTAL 186 Aggregate forms UK Interventional and Diagnostic centres 2008 2008 data: Ludman No. No No Caths PCIs cath PCI (% of total) (% of total) data data NHS 88 0 0 166,454 78,077 Interventional Private 17 11 7,026 2,254 Interventional Diagnostic 81 2na 56,548 na only TOTAL 186 230,028 80,331 Aggregate forms PCI activity to 2008 (UK) 2008 data: Ludman PCI per million PCI Procedures 1800 90000 80,331 1600 77,373 80000 73,612 1400 1308 70000 1269 1216 1200 60000 1000 50000 800 40000 600 30000 PCI per million 400 20000 PCI Procedure Numbers 200 10000 0 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Aggregate forms Rate ofincrease inPCInumberspmp Rate of Increase (%) 10 15 20 25 0 5 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Aggregate forms 2008 2008 data: Ludman PCI per Angiogram ratio 40 35 30 % 25 20 15 10 5 0 1998 1999 2000 2008 data: Ludman 2001 2002 2003 2004 2005 2006 2007 2008 Aggregate forms PCI per Angiogram ratio By Individual PCI Units 2008 data: Ludman 100 80 60 % 40 20 0 0 1000 2000 3000 Number of PCI procedures Total PCIs in the UK Countries by Type of Institution Total No.s of PCI 2008 data: Ludman 70000 2000 60000 2001 50000 2002 40000 2003 2004 30000 2005 20000 2006 10000 2007 2008 0 England England Scotland Scotland N. Ireland Wales NHS Private NHS Private Aggregate forms Total PCIs in the UK Countries by Type of Institution Total No.s of PCI 2008 data: Ludman 10000 9000 2000 8000 2001 7000 2002 6000 2003 5000 2004 4000 2005 3000 2006 2000 2007 1000 2008 0 England England Scotland Scotland N. Ireland Wales NHS Private NHS Private Aggregate forms Population estimates Mid 2008 2008 data: Ludman Total UK: 61.4 m Scotland 5.169 m Northern Ireland 1.775 m England 51.446 m est: Welsh Rx in England 0.8 m Total Rx in England 52.3 m Wales 2.99 m est: Rx in Wales: 2.2 m PCIs/million UK Countries 2008 data: Ludman 1800 1626 1600 2000 1400 1302 1339 2001 1143 1200 2002 2003 1000 2004 800 2005 600 2006 400 2007 200 2008 0 England Scotland N. Ireland Wales Aggregate forms Note: CABG data for financial yr Note: CABG data for financial PCI vs IsolatedCABGNumbers (UK) 10000 20000 30000 40000 50000 60000 70000 80000 90000 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 1991 to2008 2000 2001 2002 2003 2004 2005 2006 2007 2008 CABG PCI Aggregate forms 2008 data: Ludman PCI vs Isolated CABG Ratio (UK) 2000 to 2008 2008 data: Ludman 4 3.1 3.1 3.24 3 3 2.5 2.1 Ratio 2 1.8 1.6 1.3 1 0 001 2000 2 2002 2003 2004 2005 2006 2007 2008 Aggregate forms Number of PCIs performed in 2008 (per NHS Centre) Mean = 908 2008 data: Ludman 3500 3000 2500 2000 1500 1000 Number of PCIs 500 0 Individual Centres 26 Centres performing < 400 cases (25%) Data from: all NHS centres Aggregate forms Number of PCIs performed in 2008 7 Centres performing < 200 procedures 2008 data: Ludman Whipps Cross (2005) Kings Mill (2008) Darent Valley (2008) Lincoln County (2008) QE Woolwich (2007) Kent and Sussex (2008) Worcester Royal (2008) 0 20 40 60 80 100 120 140 160 180 200 PCI program start date Number of PCIs performed in 2008 19 Centres performing 200 to 400 procedures 2008 data: Ludman Sunderland Royal (2006) Wexham Park (2006) Birmingham City (< 2003) North Hampshire (2003) Worthing (2006) Derbyshire Royal (2005) Torbay (2004) Great Western (2006) East Surrey (2006) William Harvey (2006) Lister (2006)l Eastbourne (2006) Bradford Royal (2005) St Peter's (2003) Conquest (2007) Kettering General (2008) Frenchay (2008) Wigan Royal (2007) Hemel Hempstead (2005) 0 50 100 150 200 250 300 350 400 PCI program start date No. of Interventional Consultants (NHS centres) 2008 data: Ludman 700 40 591 600 547 35 519 30 500 441 424 25 400 362 Total 312 20 % 300 292 Increase 15 Number 200 10 100 5 0 0 2001 2002 2003 2004 2005 2006 2007 2008 Note: if work at two NHS centres will be counted twice Includes cardiologists and radiologists No. of Interventional Consultants (NHS centres 2008) 2008 data: Ludman 25 Mean 20 2000 5.5 2001 6.1 Number of 15 2002 6.5 Interventional Consultants 10 2003 6.7 2004 7.4 5 2005 7.0 2006 6.9 0 Individual Centres 2007 6.9 2008 6.8 Note: if work at two NHS centres will be counted twice No. of Consultant in each unit (NHS Centres 2008) 2008 data: Ludman 30 Mean 25 2000 5.5 20 Number of 2001 6.1 Consultants in 15 2002 6.5 each unit 10 2003 6.7 2004 7.4 5 2005 7.0 0 2006 6.9 0 500 1000 1500 2000 2500 3000 3500 2007 6.9 Total PCIs in each Unit 2008 6.8 Note: if work at two NHS centres will be counted twice No. of PCIs per Consultant (NHS Centres 2008) 2008 data: Ludman 300 250 200 150 100 50 PCIs per Consultant 0 Individual Centres Note: Data from institutional volume divided by No operators per institution Some consultants work in multiple institutions PCI per Consultant Unit case number / Number of operators 150 2008 data: Ludman 145 140 135 129 130 125 120 115 Number of PCIs Number 110 105 100 2000 2001 2002 2003 2004 2005 2006 2007 2008 No. of PCIs per Consultant (NHS Centres 2008) 2008 data: Ludman 350 300 250 Total PCIs / 200 Number of 150 Consultants 100 50 0 0 500 1000 1500 2000 2500 3000 3500 Total PCIs in each Unit Note: Data from institutional volume divided by No operators per institution Some consultants work in multiple institutions On v Off Site Surgery All Centres (NHS and private) 2008 data: Ludman 100% Off Site 28 On Site 80% 38 45 53 60% 49.5 % 40% 55 53 53 52 20% 0% 2005 2006 2007 2008 Aggregate forms On v Off Site Surgery NHS Centres only 2008 data: Ludman 100% Off Site On Site 80% 26 37 42 50 60% 40% 43% 38 38 39 20% 38 0% 2005 2006 2007 2008 Aggregate forms Surgical Cover (2008 - all 88 NHS centres) 2008 data: Ludman Off site On Site 3500 3000 2500 PCIs per 2000 Mean Centre 1500 1532 1000 500 458 0 Individual Centres Aggregate forms Surgical Cover (all 105 NHS and Private Centres) 2008 data: Ludman On site Off site No of centres 52 53 (49.5%) (50.5%) No. of PCI (% of total) 57,127 23,204 (71%) (29%) Mean No.