bcis audit returns adult interventional procedures 2002
TRANSCRIPT
BCIS Audit Returns Adult Interventional Procedures
2002
Peter F Ludman BCIS National Audit Officer
On behalf of
British Cardiovascular Intervention Society
Brighton 2003
UK Intervention Centres
52 52 53 54 54 5358 61 63 66 64 64
01020304050607080
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
No.centres
UK Interventional and Diagnostic centres 2002
No. No cath data
(%)
Caths*
(% of total)
PCIs
(% of total)
NHS Interventional
48 0 115,681 (70%)
42,007 (94%)
Private Interventional
16 1 (6%)
10,021 (6%)
2,906 (6%)
Diagnostic only
65 12 (18%)
39,471 (24%)
TOTAL 129 165,173 44,913
*Missing data assumed to be equal to previously reported activity
Centres not reporting diagnostic numbers
• Interventional – Harley Street
• Diagnostic only – Ayr Hospital – Derbyshire Royal Infirmary – Inverclyde Royal Hospital – Lister, Stevenage – Mayday University Hospital – Nevill Hall Hospital,
Abergavenny – Northwick Park Hospital – Rotherham Hospital – Royal Gwent, Newport – Salisbury District Hospital – St Mary's, Portsmouth – Sunderland Royal Hospital
Angiograms per PCI
5.2
4.3
5.7
3.84.1
3.5
4.3
2.8
4
2.8
3.7
0
1
2
3
4
5
6
1997 1998 1999 2000 2001 2002
Angio/PCI (PCI centres)
Angio/PCI (all UK)
Angiography : PCI rates Europe 2000
0
1
2
3
4
5
6
7
Ratio Angio : PCI
Lux Ice Fra Bel NorSwi
PolSpa Ita Cze Gre Fin Ger Aus Por UK
UK 2002 Hun
Annual Procedures per cath lab (NHS centres)
Mean Median Range Interventional labs Procedures (pa) per lab
1159 1148 437 to 2480
Procedures (pa) per No of weekly sessions
149 131 49 to 346
Diagnostic labs Caths (pa) per lab*
740 609 150 to 2300
Caths (pa) per No of weekly sessions*
173 153 50 to 512
*Mobile lab excluded
Number of PCIs performed in NHS Centres (total per annum)
0
2
4
6
8
10
12
<200 <400 <600 <800 <1000 <1200 <1400 <1600 <1800 <2000 >=2000
200020012002
Total UK PCI Procedures Year Centres Total
Procedures Rate per million 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 2000 66 33,652 590 20 2001 64 38,992 664 12.5 2002 64 44,913 759 14.3
Rate of increase in Procedure numbers per million
0
5
10
15
20
25
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Rat
e of
Incr
ease
(%)
Change in population estimate
590664
759
0100200
300400500
600700800
Rate per Million
'85 '88 '90 '92 '94 '96 '98 '00 '02
Year
PCI Rates per million population (UK)
Assumes UK population of: 58.8 m mid 2001, 59.2m mid 2002
Total PCIs in the UK Countries (2000 to 2002)
135 886119 922137711830072618
25610
30785
15423485
2159 11311498
40722787
35306
0500010000150002000025000300003500040000
EnglandNHS
EnglandPrivate
ScotlandNHS
ScotlandPrivate
N. Ireland Wales
200020012002
Total No.s of PCI
PCIs/million UK Countries (2000 to 2002)
0100200300400500600700800900
1000
England Scotland N. Ireland Wales
200020012002
NSF
NB Wales data does not include those treated in England
Rates of PCI (Commissioned in England 2002/3)
0
200
400
600
800
1000
1200
Rat
e pe
r mill
ion
North W
est Lond
on
South W
est Peni
nsula
South W
est Lond
on BBC
South East
Londo
n
Surrey a
nd Suss
ex
North, T
yne a
nd Wear
Leics, N
orthant
s & Rutla
nd
Hampshire
& IO
W
Co Durh
am &
Tees V
alley
Thames
Valley
West Yorkshire
N & E Yorks
and N
Lincs Essex
Dorset
& Somers
et
North Cent
ral Lond
on
North East
Londo
nBed
s and
Herts
Greater
Manche
ster
South Yorks
hire
Norfolk
, Suff
olk an
d Cam
bs
Kent an
d Medway
West M
idlands S
outh
Cumbria &
Lancas
hire
Trent
Shropshire
and S
taffs
Avon,
Gloucs
& Wilts
Cheshire
& M
erseys
ide
NSF
PCI rates versus SMR (Commissioned in England 2002/3)
0
200
400
600
800
1000
1200
0.8 0.9 1 1.1 1.2 1.3
SMR
Rat
e pe
r mill
ion
Correlation coefficient - 0.3 (p = NS)
PCI vs Isolated CABG Numbers (UK) Data from BCIS and SCTS Registry
05000100001500020000250003000035000400004500050000
'91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02
BCISSCTS
1.3 1.5 Ratio PCI:CABG ? 1.7
PCI vs CABG breakdown (Commissioned in England 2002/3)
0200400600800
10001200140016001800
North W
est Lo
ndon
South
West P
enins
ula
Co Durh
am &
Tees V
alley
Essex
Dorset
& Somers
et
N & E York
s and
N Linc
s
Cumbri
a & La
ncas
hire
BBC
North,
Tyne an
d Wear
South
West L
ondo
n
Greater
Man
ches
ter
Hamps
hire &
IOW
South
East L
ondo
n
South
Yorksh
ire
Surrey
and S
usse
x
West Yorks
hire
Thames
Valley
Leics
, Nort
hants
& Rutl
and
Norfolk
, Suff
olk an
d Cam
bs
Shrops
hire a
nd Staf
fs
North C
entra
l Lon
don
Beds a
nd H
erts
Chesh
ire & M
ersey
side
Kent a
nd M
edway Trent
West Midl
ands
Sou
th
North E
ast L
ondon
Avon,
Gloucs
& W
ilts
Rat
e pe
r mill
ion
CABG pmp PCI pmp
Ratio 1.4 : 1
PCI and CABG rates per million (Europe 2000)
0
500
1000
1500
2000
2500
Pol Gre Spa Hun Por Fin UK Ita Bel Cze Nor Lux Fra Ice Swi Aus Ger
PCICABG
1.8 1.4 4.2 0.7
2.0 0.9
1.3
2.8 1.4
2.0
1.7 4.1 5.4
3.3 2.4
3.0
2.3
Ratio PCI:CABG
Ratio PCI: CABG (Europe 2000)
0
1
2
3
4
5
6
Rat
io P
CI:C
AB
G
Hun Fin UK UK2002
Gre Bel Nor Pol Por Cze Ger Swi Ita Aus Ice Lux Spa Fra
No. of Interventional Consultants (NHS centres, UK 2002)
0
2
4
6
8
10
12
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18No of Consultants per Centre
No
of C
entr
es
Mean 2000 5.5 2001 6.1 2002 6.5
Total = 312 Includes local and visitors, cardiologists and radiologists
No of PCIs per Consultant (NHS Centres)
data from 48 centres
0
5
10
15
20
25
No
of C
entr
es
0-50 51-100 101-150 151-200 201-250 >250
No PCIs/Consultant
2001 2002
Note: data from institutional volume divided by No operators per institution
Mean PCI/consultant: 2000 125 2001 126 2002 138
Visiting Interventionists (NHS Centres 2002)
1830
84
123105
0
20
40
60
80
100
120
140
Centres with no Visitors Centres with Visitors
No of Centres No of Local Int. No of Visitors
4.7 Interventionists/Centre Mean: 156 PCIs/year
7.6 Local + Visitors/Centre Mean: 127 PCIs/year
Surgical cover (Data for 2002)
On site Off site No of centres 53 11 No. of PCI (% of total)
39763 (89%)
5150 (11%)
Mean No. procedures per centre
750 468
Operator volume: PCIs per interventionist *
149 100
* NHS Centres only
Appropriateness
• Indications – Severity of symptoms – Objective assessment of myocardial ischaemia – Angiographic disease severity – etc.
• Risk stratification – Clinical presentation – LV function – Renal function – etc.
Stent procedures 1992 - 2002 2002 data from 63 of 64 centres
84 86 86.4
0102030405060708090
100
% of Procedures
'92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02
Year
Stenting in different centres 1998-2002
2002 data from 63 of 64 centres
05
10152025303540
No
of C
entr
es
31-40 41-50 51-60 61-70 71-80 81-90 >90
% Procedures using Stents
19981999200020012002
PCI for Restenosis 1998 - 2002 (2002 data from 48 of 64 centres)
0%
10%
20%
30%
40%
50%
60%
70%
% of Centres
0-5 5.1-10 10.1-15 >15% procedures for Restenosis
19981999200020012002
PCI in patients with past CABG 2002 (Data from 45 of 64 centres)
0
5
10
15
20
25
No of Centres
0 to 5 5.1 to 10 10.1 to 15 15.1 to 20 20.1 to 25 25.1 to 30
% of procedures in patient with CABG
Note: Includes procedures on native vessels and grafts
Mean 8.4%
Use of GP IIb/IIIa blockers 2002 data from 62 of 64 centres
05
1015202530354045
% of Procedures
1997 1998 1999 2000 2001 2002
with Abciximabwith any GPIIb/IIIa
Note: Possible underestimate of small molecule use
Abciximab in different centres 1999 - 2002
2002 data from 62 of 64 centres
0
5
10
15
20
25
30
No. of Centres
0 to 10
11 to
20
21 to
30
31 to
40
41 to
50
51 to
60
61 to
70
71 to
80
81 to
90 >90
% Procedures using Abciximab
1999200020012002
Abciximab use by Clinical Presentation (2002 data from 47 of 64 units)
28.5
48.9
27.738.1
52.559.6
01020304050607080
% Procedures
with Abciximab
SV no CTOMV no CTO SV CTO
MV & CTO NSTEMI STEMI
Other Coronary Interventional Techniques (1)
2002 data from 62 of 64 centres
Units No ∆ % cf 2001
* % of all procs
** Mean
*** Range
Rotablation 27 170 +17 0.38 6.3 1-37 Atherctmy (DCA) 7 13 -54 0.03 1.9 1-4 TEC 1 12 +300 0.03 12 12 Laser 5 15 -35 0.03 3 1-9 Cutting ballon 47 1226 +37 2.7 26.1 1-93 Thrombectomy ¥ 20 147 +153 0.39 8.7 1-37 Brachytherapy 7 143 +10 0.32 20.4 7-52
*% of all UK interventional procedures **Mean number in units using the technique ***Range in units using the technique
¥PercuSurge, Rescue, Angiojet, X-sizer
Other Coronary Interventional Techniques (2)
2002 data from 62 of 64 centres
Units No ∆ % cf 2001
* % of all procedures
** Mean
*** Range
PTMR 1 28 +47 0.06 28 28
Septal ablation 2 4 +100 0.01 2 1-3
Distal protection
9 68 +94 0.15 7.6 2-19
Self reported data not specially requested
*% of all UK interventional procedures **Mean number in units using the technique ***Range in units using the technique
Non coronary cardiac intervention 2002 data from 62 of 64 centres
Units No ∆ % cf 2001
% of all procedures
** Mean
*** Range
MV plasty 33 199 -20 0.44 6 1-23
AV plasty 6 6 -65 0.01 1 1
PV plasty 9 26 -10 0.06 2.9 1-8
TV plasty 1 1 0.002 1 1
PDA 8 23 -44 0.05 2.9 1-6
ASD* 23 335 +13 0.75 14.6 2-51
PFO* 15 93 +158 0.2 6.2 1-28
VSD (self reported) 2 8 +167 0.02 4 4
* Some centres give combined data for ASD/PFO closure
Mitral Balloon Valvuloplasty 2002
22
5 3 2 10
5
10
15
20
25
Number of centres
1-5 6-10 11-15 16-20 21-25No of procedures performed
33 of 64 centres perform MBV
Great vessel intervention 2002 data from 62 of 64 centres
Units No ∆ % cf 2001
* % of all procedures
** Mean
*** Range
Coarct / Re-coart 7 33 +27 0.07 4.7 1-17 Carotid 4 76 +3700 0.17 19 1-70
Data below not specifically requested
Pulm art 2 10 0.02 5 1-9 SVC 2 7 0.02 3.5 2-5 Aorta 1 2 0.004 2 2
Other Diagnostic Techniques 2002 data from 62 of 64 centres
Units No ∆ % cf 2001
*% of all procedures
** Mean
*** Range
IVUS 36 877 +32.5% 2.0 24.4 1-217
Angioscopy 0 0 0 0 0
Data below not specifically requested Press wire 7 137 +83% 0.3 19.6 1-44
Flow wire 0 0 0 0 0
*% of all UK interventional procedures **Mean number in units using the technique ***Range in units using the technique
Other procedures 2002 data from 62 of 64 centres
Units No ∆ % cf 2001
* % of all procs
** Mean
*** Range
Foreign body removal
5 16 0.04 3.2 1-11
Embolisation 8 24 0.05 3 1-9
Groin closure 48 15,700 +85 35.0 327 4-3100
Data below not specifically requested Pericardiotomy 1 1
Spinal cord stimulator
1 22 0.002 22 22
ANY Outcome Data (form C) Inadequate or No Data
• City Hospital, Birmingham
• Yorkshire Heart Centre • University Hosp. Of Wales • Edinburgh Royal
Infirmary • London Chest • Freeman, Newcastle • Northern Gen. Hosp.
Sheffield • St Bartholomew's • Plymouth Derriford
• Ross Hall Hospital • London Independent • St Anthony's • The Priory, Birmingham • HCI, Glasgow (Golden
Jubilee National Hospital) • Harley Street Clinic • Yorkshire Clinic, Bradford • BUPA Lea (Cambridge)
HOSPITAL outcome Data (form C)
No data from: • Cath lab only
– Blackpool Victoria – Yorkshire Heart Centre – St Mary's – Papworth Hospital – Glasgow Western Infirmary – Wythenshawe, Manchester – City Gen. Hosp. Stoke – Hairmyres – BMI Alexander, Manchester – London Bridge Hospital – BUPA Leicester – Cromwell – The Priory, Birmingham – Yorkshire Clinic, Bradford – BUPA Lea (Cambridge)
• Unspecified – Belfast City – Hull RI & Castle Hill – Walsgrave Hospital, Coventry – Manchester Royal Infirmary – Heart Hospital (Middlesex/
UCH – Northern Gen. Hosp.
Sheffield – St George's – Eastbourne – Wellington Hospital – BUPA Leeds – Ross Hall Hospital – London Independent – St Anthony's – Harley Street Clinic – Bristol BUPA – Park, Nottingham
All PCI Procedures: Mortality Year Data
From: Total with
mortality data 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
2000 48/66 24,323 (33,652) 0.64 0-2.6
2001 45/64 29,001 (38,992) 0.75 0-2.8
2002 53/64 37,437 (44,913)
0.54 0-1.9
Includes all centres reporting cath lab outcome or hospital outcome
All PCI procedures: Outcome Year Vessels/
case Success
(%) MI (%)
Re PCI for acute closure
(%)
Em. CABG
(%)
Mortality (%)
1991 86 1.6 2.6 0.48 1992 1.17 88 1.4 2.0 0.71 1993 1.09 89 1.1 1.9 0.59 1994 1.15 90 1.0 1.6 0.60 1995 1.17 89 1.4 1.9 0.69 1996 1.17 90 1.4 1.7 0.72 1997 1.16 92 1.2 1.1 0.89 1998 1.24 92 0.8 0.7 0.80
1999 1.11 90 0.57 0.48 0.61
2000 1.21 92 0.6 0.4 0.64
2001 1.22 94 0.5 0.4 0.75
2002 1.23 (52 of 64)
92 (51 of 64)
0.57 (49 of 64)
0.33 (50 of 64)
0.28 (53 of 64)
0.54 (53 of 64)
Includes all centres reporting cath lab outcome or hospital outcome
All Procedures: Outcome
0.0
0.5
1.0
1.5
2.0
2.5
3.0
'91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02
%Mortalityem CABG
Stenting and outcome 1992-2002 2002 CABG data from 53, resten data from 48 of 64 centres
Year % Stented % PCI for Restenosis
% needing Em.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 2000 85 6.2 0.4 2001 87 5.4 0.4 2002 84 4.7 0.28
Stenting and the need for emergency CABG
(2002 data from 53 of 64 centres)
0
10
20
30
40
50
60
70
80
90
100
'92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02
Year
% s
tent
0
0.5
1
1.5
2
2.5
% E
m C
AB
G
% Stent% Em.CABG
Stenting and procedures for restenosis
(2002 data from 48 of 64 centres)
0
10
20
30
40
50
60
70
80
90
100
'92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02
Year
%
0
2
4
6
8
10
12
14
% % Stent% Restenosis
Centres providing complete data on HOSPITAL outcome
(2002)
• Aberdeen Royal Infirmary • Belfast Royal Victoria • Birmingham Heartlands • University Hospital,
Birmingham • Guy's and St Thomas‘ • Bristol Royal Infirmary • Hammersmith Hospital • Harefield Hospital • Kings College Hospital • Edinburgh Western • Liverpool CTC • John Radcliffe, Oxford
• Royal Brompton Hospital Glenfield, Leicester
• Royal Free • Southampton University
Hospital • James Cook, Middlesbrough • Nottingham City • KE VII, Midhurst • Morriston, Swansea • Royal Sussex, Brighton • RCH Truro, Treliske • Taunton & Somerset
Hospital Outcome 2002 Data from 23 centres
No.
Success Partial Success
Failed Repeat PCI
CABG MI Death (Range)
19606 91.5% 2.5% 3.8% 0.3% 0.24% 0.6% 0.66% (85-97) (0.5-5.4) (0.5-9.5) (0-0.7) (0-1.1) (0-3.9) (0-1.8)
All Patients
Hospital Outcome 2002 Data from 23 centres
No.
Success Partial Success
Repeat PCI
CABG MI Death (Range)
Stable Single Vessel (no CTO)
7770 95% (87-100)
1.1% (0-4.7)
0.26% (0-0.96)
0.17% (0-1.4)
0.3% (0-2.8)
0.14% (0-0.78)
Stable Multivessel (no CTO)
2434 91.9% (63-100)
5% (0-10.3)
0.08% (0-0.9)
0.29% (0-0.3)
0.62% (0-4.3)
0.33% (0-2.9)
Single Vessel CTO
1081 68.4% (44-100)
2.4% (0-10)
0.18% (0-1.4)
0.65% (0-5.4)
0.28% (0-3.1)
0.1% (0-1.0)
Multivessel Inc. CTO
814 83.7% (33-100)
11.3% (0-40)
0%
0%
0.39% (0-4.3)
0% 0
All data (cath lab, hosp outcome and unspecified) – 46 centres Stable Single Vessel (no CTO)
12,983 95% (78-100)
0.22% (0-1.1)
0.22% (0-1.4)
0.35 (0-3)
0.10% (0-0.8)
Elective Patients
Hospital Outcome 2002 Data from 23 centres
No.
Success Partial Success
Repeat PCI
CABG MI Death (Range)
CABG pts 1556 81.2%
(16-100) 2.4% (0-8.3)
0.06% (0-1.1)
0.26% (0-4.3)
0.13% (0-2.0)
0.3% (0-1.4)
Restenosis
997 92.2% (69-100)
3.2% (0-31)
0.4% (0-7.7)
0.3% (0-4)
0.7% (0-9)
0.6% (0-9)
Does not account for clinical syndrome CABG patients includes Rx of native and grafts
Patients with previous bypass grafts Patients treated for restenosis
Hospital Outcome 2002 Data from 23 centres
No. Success Partial Success
Repeat PCI
CABG Q MI Death (Range)
ACS 8256 93.6% 1.9% 0.3% 0.2% 0.5% 0.5% (50-100) (0-14) (0-25) (0-3.8) (0-25) (0-14)
Acute coronary syndromes (UA/NSTEMI)
Includes all classified as treated for UA and post MI angina (stable and unstable)
Hospital Outcome 2002 Data from 21 centres
No. Success Partial Success
Repeat PCI
CABG Q MI Death (Range)
Acute closure 78 80.7% 3.8% 3.8% 6.4% 10.3% 10.3% (0-100) (0-20) (0-75) (0-40) (0-100) (0-100)
Patients Rx for acute vessel closure
Hospital Outcome 2002 Data from 23 centres
No.
Success Partial Success
Repeat PCI
CABG re-MI Death (Range)
Primary PTCA
245 90% (0-100)
3.7% (0-15)
1.2% (0-4.8)
0%
0.8% (0-4.7)
2% (0-8)
Rescue PTCA
558 90% (0-100)
3.4% (0-100)
1.4% (0-12)
0.5% (0-5)
0.5% (0-2.8)
2.2% (0-13)
Re-MI PTCA
389 92% (0-100)
2.0% (0-50)
0.5% (0-100)
0.3% (0-1.8)
1.8% (0-100)
1.5% (0-100)
Shock 154 69% (0-100)
9.7% (0-50)
1.9% (0-50)
0.65% (0-33)
1.3% (0-33)
29% (0-100)
Patients Rx for STEMI
PCI for STEMI (2002 data from 47 of 64 units)
2174
0
500
1000
1500
2000
2500
All STEMI PrimaryPCI
Rescue For Re-MI Shock
20012002
Data from units reporting cath or hosp outcome
4.8% of all PCI activity
Hospital MACE Overview 2002 (Data from 23 centres, 19,606 patients)
0.660.24 0.170.22 0.5 0.2
10.3
6.4
2
0
2.2
0.5 0.3 0.260
2
4
6
8
10
12
%
All
Elective
UA/NSTEMISAT
PPTCAResc
ue
past CABG
Mortalityem CABG
BCIS / CCAD project
• Dataset 5.1.2 • Data collection / transmission • Pilot site experience • Future plans
Dataset • Version 5.1
– Finalised at meeting 12-2-03
• Dataset – Sections 1 to 5 (5 = optional fields) – Modifications
• Overall structure invariant for 2 years (2005) – 103 fields and short code options
• Volatile menu items can be updated at short notice (8) – On BCIS web site and CCAD web site
• www.bcis.org.uk/ • www.ccad.org.uk/ccadweb.nsf
CCAD Central Server
Local Lotus Notes Database
Encr
yptio
n
The Basic CCAD Package
• Lotus Notes front end • Local database • Encrypted link to CCAD • Maintained centrally
– Automatic menu update – Automatic software update
Limitations: • One computer for data input • Difficulties linking with other
hospital systems • No lesion specific data
Connection to other Databases
Item 1 Item 2 Item 3 Item 103 ……
Patient 1 Patient 2
Patient n
…..
Comma separated values file
CCAD Central Server
Local Lotus Notes Database
Encr
yptio
n
Definition: www.ccad.org.uk See CCAD downloads
PCI Database on
Hospital Server Lab results server
PAS server
Audit clerk
SpR or consultant computer
Cath lab data entry
Fu data entry
Include partial data, updated by subsequent transfers
CCAD Central Server
Local Lotus Notes Database
Encr
yptio
n
CCAD Central Server
Local Lotus Notes Database
Encr
yptio
n
Data completeness Procedure - indications Procedural details Procedure - outcome
CCAD Central Server
Local Lotus Notes Database
Encr
yptio
n
Data completeness Procedure - indications Procedural details Procedure - outcome
CCAD Central Server
Local Lotus Notes Database
Encr
yptio
n
Data completeness Procedure – indications Procedural details Procedure - outcome
Analysis of CCAD dataset • Benchmarking
– Any unit can compare their practice with UK wide average using Lotus Notes software (as MINAP)
• ONS link – Post discharge event free outcome
• Death, re-intervention etc. • BCIS Council position
– Additional analysis to be arranged • ? via University statistical department
– Methodology of analysis controlled by the profession via BCIS
– ? 3 year cycle of results analysis – Data monitoring committee as a means of peer review – Accept that the type of analysis will continue to evolve
BCIS / CCAD pilot sites
Name Status IT Tool University Hospital Birmingham
On Line – Sept 2002 Access db (PFL)
James Cook University Hospital
On Line – April 2003 Access db in house development
Royal Brompton Dendrite, link evolving Bristol Cardis, link evolving Exeter Long way off Southampton First download planned
1/04
Walsgrave Hospital Dendrite - Intermittent downloads
Papworth Hospital Tomcat, link evolving Kings College Hospital Dendrite, software failed
Oct 2003
London Chest Hospital Tomcat, link evolving
Plans
• Pilot sites continue • Encourage other sites to start
collecting dataset version 5.1 – decide on system to be used – contact CCAD for Lotus gateway set up
instructions – 0207 391 8028
• Full roll out by April 2004
Conclusions • Steady increase in PCI activity in UK
– England and Scotland • NSF rates for PCI have been exceeded
– Increase in PCI:CABG ratio – MACE rates remain satisfactory
• BCIS-CCAD project – Important progress
Extra Information • Additional slides with details of
– Dataset version 5.1 version code – Volatile menu items
Dataset – Version Code
• Version history – 5.1 as ‘finalised’ in Feb 2003 – 5.1.1 as presented at London Roadshow – 5.1.2 as presented at Leeds Roadshow
• Plan to present BCIS and SCTS datasets to ISB Jan 2003
Dataset – Version Code
5.1.2 Version 6: After approval of definitions by the Information Standards Board
Dataset – Version Code
5.1.2
Increments whenever a new menu item is added to volatile lists (e.g. new DES)
Version 6: After approval of definitions by the Information Standards Board
Dataset – Version Code
5.1.2 Version 6: After approval of definitions by the Information Standards Board
Increments whenever a new menu item is added to volatile lists (e.g. new DES)
Increments with subtle changes in text , typos, clarification of definitions etc.
Dataset Maintenance
Central Repository (IA)
Dataset details Field numbers, Field prompts, Short and long codes Definition and notes Format details
Excel Workbook BCIS Web site Dataset
CCAD Lotus Notes Dataset
help text / files
NHS Data Dictionary
Dataset fields • Important aspects not contained in current
dataset – (Structure) – Appropriateness – Process – Outcome
• Current definitions of clinical syndromes • Track the use of new equipment
– Drug eluting stents – Distal protection – Etc.
Dataset 5.1 examples
• Indication for intervention – 1. Stable – angina – 2. Stable – coronary anatomy – 3. ACS – no acute STEMI – 4. ACS - primary PCI for STEMI (no lysis) – 5. ACS – Facilitated PCI for STEMI (lysis + PCI) – 6. ACS – Rescue PCI (failed lysis) – 7. ACS – PCI for re-infarction no lysis – 8. ACS – Rescue PCI for re-infarction (failed lysis) – 9. Staged procedure – 10. Hybrid procedure – 11. Acute / subacute thrombosis at recent PCI site (30/7) – 12. Bail out following diagnostic cardiac catheterisation
Dataset 5.1 – Event Timing STEMI
(anterior ST elevation)
Thrombolysis
Good resolution
More chest pain ST depression
Cath and proceed to LAD PCI
Awaiting ETT pre Dx
Date/time 1
Date/time 2 PCI data
Time: Date/time 2 ECG: ST depression
Volatile menus • 8 fields with volatile menu items
– Drug Eluting Stents – Emboli protection – Diagnostic devices – Procedural devices – Thrombus removal – Brachytherapy – Arterial access management – Peri-procedure drugs
Volatile menus
• Any potential changes to be directed to BCIS audit secretary (PFL) – Discussed with BCIS Council audit committee – CCAD informed
• update dataset version held with Tony Dallimore – update spreadsheet on BCIS – update CCAD web site and Lotus Notes
Dataset stakeholders
• BCIS – Detailed analysis of most of dataset – Track activity and changes in patterns of Rx
• Structure • Appropriateness • Process • Outcome
• Roger Boyle – NHS data – Appropriate professional self regulation
• DOH (general public) – Provision of safe care
• Hospital outcome of stable SV disease