BCIS Audit Returns
Adult Interventional Procedures
Jan 2004 to Dec 2004
Peter F Ludman
BCIS National Audit Officer
On behalf of
British Cardiovascular Intervention Society
Bristol 2005
Audit Domains
2004 data: Ludman
•
•
•
•
Structure
Appropriateness
Process
Outcome
Angiography Centres - 2004
19 New Angiography Only centres 2004
2004 data: Ludman
Bedford Hospital
Darlington Memorial
Scunthorpe
Solihull Hospital
Durham
East Surrey
Kent and Sussex
King George Hospital Ilford
South Tyneside
South Warwickshire
University Hospital Aintree
Wansbeck, Ashington
King's Mill Centre, Mansfield
Lincoln County Hospital
Princess Alexandra, Harlow
Westmorland General Hosp
Wexam Park
Whipps Cross
Russells Hall
Angiography Centres - 2004
2004 data: Ludman
1 Stopped
North Tyneside (to Freeman Hospital)
1 Swapped
St Albans → fixed lab in Hemel Hempstead
3 Started PCI in 2004
Torbay
BUPA Hull
Southend
TOTAL: 83 Angiography Only Centres
(increase of 15 from 2003)
PCI Centres - 2004
2004 data: Ludman
3 Angio only centres now performing PCI in 2004
1. Torbay
2. Southend
3. BUPA Hull
New PCI centres in 2003
1.
Manor Hospital, Oxford
TOTAL: 77 PCI Centres
(increase of 4 from 2003)
UK Centres - 2004
2004 data: Ludman
PCI
Angio only
100
60
52 52 53 54 54 53
63 66 64 64
61
58
73
83
65 68
40
20
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
0
1991
No.centres
80
77
PCI Centres NHS (1)
2004 data: Ludman
England
1
Battle Hospital
Reading
16
John Radcliffe Hospital
Oxford
2
Birmingham City Hospital
Birmingham
17
King Edward VII
West Sussex
3
Birmingham Heartlands Hospital
Birmingham
18
Kings College Hospital
London
4
Bristol Royal Infirmary
Bristol
19
Liverpool CTC
Liverpool
5
Castle Hill Hospital
Cottingham
20
London Chest Hospital
London
6
Cheltenham General Hospital
Cheltenham
21
Manchester Royal Infirmary
Manchester
7
City General Hospital
Stoke on Trent
22
New Cross Hospital
Wolverhampton
8
Derriford Hospital
Plymouth
23
North Hampshire Hospital
Basingstoke
9
Eastbourne Hospital
Eastbourne
24
Northern General Hospital
Sheffield
10
Freeman Hospital
Newcastle
25
Northwick Park Hospital
Harrow
11
Glenfield Hospital
Leicester
26
Nottingham City Hospital
Nottingham
12
Hammersmith Hospital
London
27
Papworth Hospital
Cambridge
13
Harefield Hospital
Uxbridge
28
Queen Elizabeth Hospital
Birmingham
14
Heart Hospital
London
29
Royal Brompton Hospital
London
15
James Cook University Hospital
Middlesbrough
PCI Centres NHS (2)
2004 data: Ludman
England (cont)
30
Royal Cornwall Hospital
Truro
40
St Peter's Hospital
Chertsey
31
Royal Devon & Exeter
Exeter
41
St Thomas' Hospital
London
32
Royal Free Hospital
London
42
Taunton & Somerset
Taunton
33
Royal Sussex County Hospital
Brighton
43
Torbay Hospital
Torquay
34
Sandwell District General
West Bromwich
44
Victoria Hospital
Blackpool
35
Southampton General
Southampton
45
Walsgrave Hospital
Walsgrave
36
Southend
46
Wythenshawe Hospital
Manchester
37
St Bartholomew's Hospital
47
Yorkshire Heart Centre
Leeds
38
St George's Hospital
London
39
St Mary's Hospital
London
London
PCI Centres NHS (3)
2004 data: Ludman
PCI Centres NHS Scotland
48
Aberdeen Royal Infirmary
Aberdeen
49
Edinburgh Royal Infirmary
Edinburgh
50
Glasgow Royal Infirmary
Glasgow
51
Glasgow Western Infirmary
Glasgow
52
Golden Jubilee National Hospital (formerly HCI)
Clydesbank
53
Hairmyres Hospital
East Kilbride
54
Western General Hospital
Edinburgh
PCI Centres NHS Wales
55
Morriston Hospital
Swansea
56
University Hospital of Wales
Cardiff
PCI Centres NHS Northern Ireland
57
Belfast City Hospital
Belfast
58
Royal Victoria Hospital
Belfast
PCI Centres - Private
2004 data: Ludman
England
59
BMI Alexandra Hospital
Cheadle
70
Harley Street Clinic
London
60
BMI Park Hospital
Arnold
71
Leeds Nuffield Hospital
Leeds
61
BMI Priory Hospital
Edgbaston
72
London Bridge Hospital
London
62
BUPA Cambridge Lea
Impington
73
London Independent
London
63
BUPA Hospital Bristol
Redland Hill
74
Manor Hospital
Headington
64
BUPA Hospital Hull
Anlaby, Hull
75
St Anthony's Hospital
Surrey
65
BUPA Hospital Leeds
Roundhay
76
Wellington Hospital
London
66
BUPA Hospital Leicester
Oadby
67
BUPA Hospital Southampton
Southampton
68
Capio Yorkshire Clinic
Bingley
69
Cromwell Hospital
London
Scotland
77
Ross Hall Hospital
Glasgow
Angiography Only Centres (1)
2004 data: Ludman
1
Airedale General Hospital
2
Altmagelium Hospital
3
Arrowe Park Hospital
4
Ayr Hospital
5
Bedford Hospital NHS Trust
6
BMI The Princess Margaret Hospital
7
BMI Thornbury Hospital
8
Bradford Royal Infirmary
9
Broomfield Hospital
10
BUPA Hospital, Little Aston
11
BUPA Murrayfield Hospital
12
Calderdale Royal Hospital
13
Conquest Hospital
14
County Hospital
15
Craigavon Hospital
16
Cumberland Infirmary
17
Darlington Memorial Hospital
18
Derbyshire Royal Infimary
19
Dewsbury and District Hospital
20
Diana Princess of Wales Hospital
21
Doncaster Royal Infirmary
22
Droitcwich Spa Hospital
23
Dudley Group of Hospitals
24
Dumfries & Galloway Royal Infirmary
25
Ealing Hospital
26
East Surrey Hospital
27
Good Hope District General Hospital
28
Goring Hall Hospital
29
Great Western Hospital
30
Harrogate District Hospital
31
Hemel Hempstead General
32
Huddersfield Royal Infimary
33
Inverclyde Royal Hospital
34
Kent and Sussex Hospital
35
King George Hospital
36
Kings Mill Hospital
Angiography Only Centres (2)
2004 data: Ludman
37
Lincoln County Hospital
50
Queens Medical Centre
38
Lister Hospital
51
Raigmore Hospital
39
Manor Hospital
52
Rochdale Infirmary
40
Mayday University Hospital
53
Rotherham Hospital
41
Nevill Hall Hospital
54
Royal Bournemouth Hospital
42
Ninewells Hospital
55
Royal Gwent Hospital
43
Norfolk & Norwich Hospital
56
Royal Liverpool University Hospital
44
North Middlesex Hospital
57
Royal Shrewsbury Hospital
45
North Staffordshire Nuffield Hospital
58
Royal Surrey County Hospital
41
Northampton General Hospital
59
Royal United Hospital
42
Pinderfields General Hospital
60
Salisbury District Hospital
43
Prince Philip Hospital
61
Scunthorpe General Hospital
44
Princess Alexandra Hospital
62
Solihull Hospital
45
Princess of Wales Hospital
63
South Tyneside District Hospital
46
Princess Royal Hospital
64
South Warwickshire NHS Trust
47
Princess Royal University Hospital
64
St James' University Hospital
48
Queen Elizabeth Hospital
65
St. Mary's Hospital
49
Queen Elizabeth Hospital
Angiography Only Centres (3)
2004 data: Ludman
66 Sunderland Royal Hospital
67 University Hospital Aintree
68 University Hospital of North Durham
69 Wansbeck Hospital
70 West Cumberland Hospital
71 Westmorland General Hospital
72 Wexham Park Hospital
73 Whipps Cross University Hospital
74 Worcester Royal Hospital
75 Worthing Hospital
76 Wycombe Hospital
77 York District General Hospital
2004
2004 data: Ludman
PCI centres
77
Angiography only
Centres
83
UK Interventional and Diagnostic centres
2004
2004 data: Ludman
No.
No No
cath PCI
data data
58
4
3
NHS
Interventional
Private
19
Interventional
Diagnostic
83
only
TOTAL
160
2
12
Missing cath data estimated from 2003 figures
1
Caths
PCIs
(% of total)
(% of total)
UK Interventional and Diagnostic centres
2004
2004 data: Ludman
No.
No No
Caths
cath PCI (% of total)
data data
58
4
3
139,978
NHS
Interventional
Private
19
Interventional
Diagnostic
83
only
TOTAL
160
2
1
12
Missing cath data estimated from 2003 figures if known
PCIs
(% of total)
59,532
(70%)
(95%)
9,956
3,248
(5%)
(5%)
51,446
(25%)
201,380
62,780
Centres Not Reporting
PCI numbers for 2004
2004 data: Ludman
•
•
•
•
Southend
St Peter's Hospital, Chertsey
(Belfast City Hospital – very late)
BMI Park Hospital
UK Interventional and Diagnostic centres
2004
2004 data: Ludman
No.
No No
Caths
cath PCI (% of total)
data data
58
4
3
139,978
NHS
Interventional
Private
19
Interventional
Diagnostic
83
only
TOTAL
160
2
1
12
Missing cath data estimated from 2003 figures if known
PCIs
(% of total)
59,532
(70%)
(95%)
9,956
3,248
(5%)
(5%)
51,446
(25%)
201,380
62,780
PCI per Angiogram ratio
2004 data: Ludman
35
30
Angio/PCI
(all UK)
25
20
%
15
10
5
0
1998 1999 2000 2001 2002 2003 2004
F
Sl ran
ov ce
N enia
or
Po way
l
S w S w and
itz ede
er n
la
nd
Bu Ita
lg ly
Lu Den ari
xe m a
m ark
bo
Ic urg
C
e
ze
ch Cr land
Re oat
p ia
H ub
un lic
B e ga
lg ry
iu
Sp m
Au ain
Po str
rtu ia
C ga
y l
Fi pru
G nl a s
e n
U
ni L rm d
te ith an
d u y
Ki an
n i
R gdo a
om m
S l an
ov ia
G akia
re
Tu ece
rk
L a ey
tv
ia
PCI per Angiogram ratio
ESC Survey 2003
Cook S for Working Group on Interventional Cardiology (WG 10) of the ESC In Press
2004 data: Ludman
60
50
40
% 30
20
10
0
20
20
20
20
20
19
19
19
19
19
19
19
19
19
04
03
02
01
00
99
98
97
96
95
94
93
92
91
Rate of Increase (%)
Rate of increase in PCI numbers pmp
2004 data: Ludman
25
20
15
10
5
0
PCI activity to 2004 (UK)
2004 data: Ludman
PCI per million
PCI Procedures
1200
80000
PCI per million
1000
1050
70000
53,261
894
800
60000
50000
600
40000
30000
400
20000
200
10000
0
0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
PCI Procedure Numbers
62,780
Total PCIs in the UK Countries
2004 data: Ludman
Total No.s of PCI
60000
50941
50000
42234
2000
2001
2002
2003
2004
40000
30000
20000
10000
0
3396
3148
5095
4438
110
100
1988
1775
England England Scotland Scotland N. Ireland
NHS
Private
NHS
Private
1632
1308
Wales
Population estimates
Mid 2004
2004 data: Ludman
Total UK: 59.8 m
Scotland 5.08 m
Northern Ireland 1.71 m
England 50.09 m
Welsh Rx in England 0.7 m
Total Rx in England 50.79 m
Wales 2.95 m
Rx in Wales: 2.25 m
PCIs/million UK Countries
(2000 to 2004)
2004 data: Ludman
1400
1200
1000
1163
1003
903
1003
1044
899
725.3
800
592
600
400
200
0
England
Scotland
N. Ireland
Wales
2000
2001
2002
2003
2004
PCI vs Isolated CABG Numbers (UK)
Data from BCIS and SCTS Registry
2004 data: Ludman
70000
60000
50000
BCIS
SCTS
40000
30000
20000
10000
Note:
CABG data for financial yr
all PCI v NHS CABG
CABG data for 2003 and 2004 from DoH
2004
2003
2002
2001
1999
2000
1998
1997
1995
1996
1994
1993
1992
1991
0
PCI vs Isolated CABG Ratio (UK)
Data from BCIS and SCTS Registry
2004 data: Ludman
3
2.5
2.1
2
1.8
1.6
%
1.3
1
04
20
03
20
02
20
01
20
20
00
0
Cardiovascular Diseases in Europe 2004
www.escardio.org/knowledge/ehs/slides/
Euro Heart Survey 3rd Report
Cardiovascular Diseases in Europe 2004
www.escardio.org/knowledge/ehs/slides/
Euro Heart Survey 3rd Report
Annual Procedures per cath lab
(NHS centres)
2004 data: Ludman
Interventional labs
Procedures (pa)
Mean
Median
Range
1148
1093
543 to 2304
449
408
36 to 856
669
544
40 to 2786
per lab
PCIs (pa)
per lab
Diagnostic labs
Caths (pa) per lab*
Number of PCIs performed in NHS Centres
(Total Per Annum)
2004 data: Ludman
Number of PCIs
3000
2500
2000
1500
1000
500
0
Individual Centres
Data from: 57 of 58 centres (2 centres estimated data)
Day Case PCI
• 22 of 77 Units performing day case PCI
– Total of 3018 procedures performed (21% increase cf 2003)
– 4.8% of all PCI procedures (4.6% 2003)
Number of PCIs
700
600
500
400
300
200
100
0
Individual Centres
Data from: 64 of 77 centres
2004 data: Ludman
No. of Interventional Consultants
(NHS centres)
2004 data: Ludman
500
25
424
Number
400
300
20
362
292
312
15
%
200
10
100
5
0
0
2001
2002
2003
Data from: 57 of 58 centres
Note: if work at two NHS centres will be counted twice
Includes cardiologists and radiologists
2004
Total
Increase
No. of Interventional Consultants
(NHS centres)
2004
2004 data: Ludman
20
18
16
14
Number of 12
Interventional 10
Consultants 8
6
4
2
0
Mean
2000 5.5
2001 6.1
2002 6.5
2003 6.7
2004 7.4
Individual Centres
No. of PCIs per Consultant
(NHS Centres) 2004 data from 56 of 58 centres
2004 data: Ludman
450
PCIs per Consultant
400
Mean
PCI/consultant
2000 125
2001 126
2002 138
2003 139
2004 143
350
300
250
200
150
100
50
0
Individual Centres
Note: data from institutional volume divided by No operators per institution
Visiting Interventionists
(NHS Centres) 2004 data from 57 of 58 centres
2004 data: Ludman
50
42
40
Number
30
of
centres 20
10
2002
2003
2004
15
0
In house
only
With
visitors
Type of Centre
Visiting Interventionists
(NHS Centres)
2004 data: Ludman
Mean No. of
Operators per
centre
10
8.5
8
6
4.6
4
2
0
In House Only
With Visitors
Type of Centre
Surgical Cover
(NHS Centres)
2004 data: Ludman
No of centres
No. of PCI
(% of total)
Mean No. procedures
per centre
Operator volume:
PCIs per interventionist *
On site
Off site
57
20
(74%)
(26%)
53,390
9390
(85%)
(15%)
936.7
494.2
164.6
104.3
STEMI
Primary PCI for STEMI
2004 data: Ludman
• Do you offer at least some PCI for STEMI?
NHS Centres
Yes, 51,
93%
No, 4,
7%
Data from: 55 of 58 centres
Primary PCI
Routine Rx for STEMI
2004 data: Ludman
Working Hours Only
24/7
100%
100%
80%
80%
60%
60%
40%
40%
20%
16
28
0%
20%
0%
2004
2005
Number of Centres
Data from: 55 of 58 centres
7
13
2004
2005
Primary PCI
Routine Rx for STEMI
2004 data: Ludman
Working Hours Only
24/7
100%
100%
80%
80%
60%
60%
40%
40%
20%
16
28
0%
20%
0%
2004
Data from: 55 of 58 centres
2005
7
13
2004
2005
PCI for STEMI
(2004 NHS Hospitals: data from 48 of 58 units)
2004 data: Ludman
4000
3500
3447
5.5% of all PCI activity
3000
2500
2000
1500
1438
1000
1353
482
500
345
0
All STEMI Primary
PCI
Rescue For Re-MI Shock
2001
2002
2003
2004
PCI for STEMI
(2004 NHS Hospitals: data from 48 of 58 units)
2004 data: Ludman
4000
3500
3447
3000
2500
2000
1500
1000
2304
1438
1353
1060
633
500
482
416
345
278
0
All STEMI Primary
PCI
Rescue For Re-MI Shock
2001
2002
2003
2004
PCI for All STEMI
2004 data from 48 of 58 centres
Total 3447 procedures
2004 data: Ludman
300
250
200
Number of
150
Procedures
100
50
0
Hospitals
No data
PCI for All STEMI
2004 data from 48 centres
Total 3447 procedures
2004 data: Ludman
2003
2004
300
250
200
Number of
150
Procedures
100
50
0
Hospitals
Primary PCI for STEMI
2004 data from 48 centres
Total 1438 procedures
2004 data: Ludman
200
180
160
140
120
Number of
100
procedures
80
60
40
20
0
Hospitals
No data
Primary PCI for STEMI
2004 data from 48 centres
Total 1438 procedures
2003
2004
200
180
160
140
120
Number of
100
procedures
80
60
40
20
0
Hospitals
2004 data: Ludman
Primary PCI for STEMI
2004 data: Ludman
Primary PCI as %
As Percentage of Each Centre’s PCI Activity
20
18
16
14
12
10
8
6
4
2
0
Individual Centres
Primary PCI – the experience
2004 data: Ludman
800
600
400
200
0
K
ra
ko
w
D
en
m
ar
k
C
ze
ch
B
oh
em
W
ia
es
tM
id
s
Yo
rk
sh
ire
Lo
nd
on
Primary
PCI pmp
Primary PCI – the experience
2004 data: Ludman
800
600
Primary
PCI pmp
400
200
K
ra
ko
w
D
en
m
ar
k
C
ze
ch
B
oh
em
W
ia
es
tM
id
s
Yo
rk
sh
ire
Lo
nd
on
0
UK population 60 million, at 500 pmp = 30,000 procedures pa
UK Activity 2004
1050 pmp
100000
1546 pmp
100000
90000
90000
80000
80000
70000
62780
60000
50000
50000
40000
40000
2.3 %
20000
10000
0
92,780
70000
60000
30000
2004 data: Ludman
30000
20000
1438
10000
0
32 %
30,000
All PCI
Primary PCI
UK Growth
assuming no ↑ in other PCI pmp
1050 pmp
100000
1546 pmp
100000
90000
90000
80000
80000
70000
62780
60000
50000
50000
40000
40000
0
32 %
+ 30,000 PPCI
2.3 %
20000
10000
92,780
70000
60000
30000
2004 data: Ludman
30000
20000
1438
10000
0
30,000
All PCI
Primary PCI
UK Growth
assuming no ↑ in other PCI pmp
1050 pmp
100000
1546 pmp
100000
90000
90000
80000
80000
70000
62780
60000
50000
50000
40000
40000
2.3 %
20000
10000
0
92,780
70000
60000
30000
2004 data: Ludman
30000
20000
1438
10000
0
32 %
30,000
All PCI
Primary PCI
Uncertainties
2004 data: Ludman
1546 pmp
100000
PPCI patients
50% SVD
30% staged PCI later
Overall PCI rate increasing
92,780
90000
80000
70000
60000
50000
Current lysis patients
60% angiography
40000
30000
20000
10000
0
30,000
All PCI
Primary PCI
PCI for Stable v ACS
• Of Total PCIs performed
– 44% ACS (excluding STEMI)
– 50% Elective
% PCIs for NSTEMI /
UA
80
70
60
50
40
30
20
10
0
Individual Centres
PCI for Stable v ACS
• Of Total PCIs performed
% of PCIs for Stable Sx
– 44% ACS (excluding STEMI)
– 50% Elective
90
80
70
60
50
40
30
20
10
0
Individual Centres
Audit Domains
•
•
•
•
Structure
Appropriateness
Process
Outcome
Stent procedures
2004 data from 60 of 77 centres
2004 data: Ludman
100
90
80
70
60
% of
50
Procedures
40
30
20
10
0
93.4
'92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04
Year
Stenting in Different Centres
Number of PCIs
2004 data: Ludman
100
90
80
70
60
50
40
30
20
10
0
Individual Centres
Drug Eluting Stent cases
2004 data from 69 of 77 centres
2004 data: Ludman
60
53 51
% DES cases
50
40
28
30
17
20
10
Mean
Median
?
?
0
2002
NHS and private
2003
2004
Drug Eluting Stent cases
2004 data from 53 of 58 centres
2004 data: Ludman
60
48
% DES Cases
50
50
40
29
30
10
2003
2004
18
20
0
14
5
Scotland
England
Wales
Country
NHS only
54
52
N. Ireland
DES use by Centre (NHS)
2004 data: Ludman
% Cases Using DES
England
Scotland
90
80
70
60
50
40
30
20
10
0
Individual Centres
Drug Eluting Stent cases
2004 data from 53 of 58 centres
2004 data: Ludman
100
83.7
80
%
60
43.7
40
20
0
NHS
Private
PCI for Restenosis
(2004 data from 54 of 77 centres)
Mean:
2002 4.9%
2003 4.3%
2004 3.6%
2004 data: Ludman
10
9
8
7
6
% PCIs for
5
Restenosis 4
3
2
1
0
Individual Centres
Bare Metal and DES use
v PCI for Restenosis
2004 data: Ludman
100
14
90
12
80
70
10
60
8
50
40
6
30
4
20
2
10
0
0
'92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04
% Stent
%DES
% Restenosis
PCI in patients with past CABG
(Data from 53 of 77 centres)
Mean
2002 8.4%
2003 6.8%
2004 6.7%
2004 data: Ludman
25
%of all PCIs
20
15
10
5
0
Individual Centres
Note: Includes procedures on native vessels and grafts
Use of GP IIb/IIIa blockers
2004 data from 71 of 77 centres
Overall mean % use
48.4
41.9
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
50
45
40
35
30
% of
25
Procedures 20
15
10
5
0
2004 data: Ludman
with Abciximab
with any GPIIb/IIIa
Abciximab use by Clinical Presentation
2004 data: Ludman
69
50
48
49
33
2002
2003
2004
I
EM
ST
MI
TE
NS
&C
TO
MV
O
CT
SV
O
CT
no
MV
no
CT
O
27
SV
% Procedures
with
Abciximab
80
70
60
50
40
30
20
10
0
Multi-vessel Treatment
Excluding Rx of STEMI
2004 data: Ludman
100
90
21
23
27
% Cases
80
70
28
28
60
MV
SV
50
40
79
77
73
72
72
2000
2001
2002
2003
2004
30
20
10
0
Multi-vessel Treatment
Excluding Rx of STEMI
2004 data: Ludman
70
60
50
% MV PCI
40
30
20
10
0
Individual Centres
Multi-vessel Treatment
All Clinical Presentations
2
1.9
1.8
1.7
1.6
1.5
1.4
1.3
1.2
1.1
1
Mean (Range)
04
1.27
20
03
1.23
20
02
1.23
20
01
20
00
1.21
20
Vessels /Case (centre data)
2004 data: Ludman
1.28
Multi-vessel Treatment
Excluding Rx of STEMI
2004 data: Ludman
1.8
1.7
1.6
1.5
Vessels per
1.4
PCI
1.3
1.2
1.1
1
Individual Centres
Additional Interventional Coronary
Techniques (1)
2004 data from 74 of 77 centres
2004 data: Ludman
Units
No
∆ % cf
2003
33
338
+17%
0.54
10
1-54
7
11
-27%
0.017
1.6
1-7
TEC
2
2
-33%
0.003
1
1
Laser
3
61
+177%
0.1
20
1- 47
Cutting balloon
51
1169
-12%
1.8
23
1-328
Rotablation
Atherctmy
(DCA)
* % of all
Mean** Range
procs
*% of all UK interventional procedures
**Mean number in units using the technique
Additional Interventional Coronary
Techniques (2)
2004 data from 74 of 77 centres
2004 data: Ludman
Units
No
∆ cf
2003
% of all
procs
Mean
Range
Thrombectomy
31
363 +12 %
0.58
12
1-56
Distal protection
46
550 + 59 %
0.87
12
1-67
Brachytherapy
4
59
0.09
14.7
4-21
-50%
Other
Interventional Techniques
2004 data from 74 of 77 centres
2004 data: Ludman
Units
No
∆ cf
2003
PTMR
1
7
- 61%
0.01
7
7
Septal ablation
13
57
0%
0.1
4.4
1-12
% of all
Mean
procedures
Range
Alcohol Mediated Septal Ablation
(HOCM)
Total 57 procedures
Number of Procedures
12
10
8
6
4
2
0
Individual Centres
2004 data: Ludman
Other Diagnostic Techniques
2004 data from 74 of 77 centres
2004 data: Ludman
Units
No
∆ cf 2003
% of all
procedures
Mean
Range
IVUS
38
689
+ 18%
1.1
18
1-167
Press wire
42
1281
+ 30.5%
2
31
1-169
Flow wire
6
119
+ 1387%
0.2
20
1-98
Adult non coronary intervention
2004 data from 74 of 77 centres
2004 data: Ludman
MV plasty
AV plasty
PV plasty
TV plasty
PDA
ASD
PFO
VSD
Units
No
∆ cf
2003
33
165
-28%
0.26
5
1-18
9
22
+29%
0.04
2.4
1-5
9
26
+4%
0.04
2.9
1-9
2
2
NA
1
1-2
9
39
+2.6%
0.06
4.3
1-19
28
475
+5.6%
0.8
17
2-74
28
379
+94%
0.6
14
1-86
14
34
+6%
0.05
2.4
1-6
% of all
Mean
procedures
Range
Mitral Balloon Valvuloplasty
Total 165
2004 data: Ludman
Number of MBV Procedures
18
16
14
12
10
8
6
4
2
0
Individual Centres
Adult great vessel intervention
2004 data from 74 of 77 centres
2004 data: Ludman
Units
No
∆ cf
2003
Coarct / Re-coart
Carotid
Aorta
Pulm art
9
4
2
8
35
29
7
32
-60%
+7%
-41%
+3%
0.06
0.04
0.01
0.05
3.4
7.25
3.5
4
1-9
1-19
1-6
1-9
SVC
8
34
-42%
0.05
5.9
1-17
% of all
Mean Range
procedures
Other procedures
2004 data from 74 of 77 centres
2004 data: Ludman
Units
No
∆ % cf
2002
% of all
procs
Mean
Range
Foreign body
removal
Embolisation
11
27
-4%
0.04
2.4
1-9
9
27
-51%
0.03
2.4
1-7
Balloon
Pericardiotomy
3
3
-78%
0.004
1
1
Spinal cord
stimulator
3
28
+115%
0.04
9
1-20
Radial Artery Access
6457 cases: 10.2% of all PCI
80
70
60
50
% Cases
using Radial 40
Access
30
20
10
0
Individual Centres
Data from: 68 of 77 centres
2004 data: Ludman
Femoral artery closure devices
2004 data from 69 of 77 centres
Mean: 45%
% PCIs
using a
Closure
Device
2004 data: Ludman
100
90
80
70
60
50
40
30
20
10
0
Individual Centres
Audit Domains
•
•
•
•
Structure
Appropriateness
Process
Outcome
Mortality - All PCIs
To end of PCI or hosp discharge
Year
Data
From
1995
1996
1997
1998
1999
2000
2001
2002
2003
35/54
37/53
41/58
44/61
48/63
48/66
45/64
53/64
64/73
2004 66/78
2004 data: Ludman
Total with
Mortality
mortality
Range %
%
data
11,365
(53,261)
0.69
0.72
0.91
0.80
0.61
0.64
0.75
0.54
0.53
0-3.4
0-3.2
0-10
0-9.1
0-4
0-2.6
0-2.8
0-1.9
0-2.0
56,027
(62,780)
0.56
0-2.2
(17,344)
14,476
(20,511)
17,577
(22,902)
16,946
(24,899)
20,975
(28,133)
24,323
(33,652)
29,001
(38,992)
37,437
(44,913)
49,194
MACE - All PCIs
2004 data: Ludman
To end of PCI or hosp discharge
Year
%
Procedure
Success
% QMI
1995
89
1.4
1.9
0.69
1996
90
1.4
1.7
0.72
1997
92
1.2
1.1
0.89
1998
92
0.8
0.7
0.80
1999
90
0.57
0.48
0.61
2000
92
0.6
0.4
0.64
2001
94
92
0.5
0.57
0.33
0.4
0.28
0.75
0.54
(51 of 64)
(49 of 64)
(50 of 64)
(53 of 64)
(53 of 64)
2002
2003
2004
Mortality
% Re PCI for
% Em. CABG
acute closure
(%)
92
0.36
0.17
0.29
0.53
(62 of 73)
(56 of 73)
(62 of 73)
(64 of 73)
(64 of 73)
93.5
0.30
0.30
0.21
0.56
(63 of 78)
(57 of 78)
(61 of 78)
(64 of 78)
(66 of 78)
All Procedures: Outcome
2004 data: Ludman
3.0
2.5
2.0
Mortality
em CABG
% 1.5
1.0
0.5
0.0
'91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04
Data on HOSPITAL outcome
(2004 data 43 of 77 sites)
Birmingham City Hospital
Birmingham
Bristol Royal Infirmary
Bristol
Castle Hill Hospital (Hull and East Yorkst)
Cottingham
Cheltenham General Hospital
Cheltenham
Derriford Hospital
Plymouth (limited data)
Freeman Hospital
Newcastle upon Tyne
Hammersmith Hospital
London
Harefield Hospital
Uxbridge
James Cook University Hospital
Middlesbrough
John Radcliffe Hospital
Oxford
King Edward VII
West Sussex
Kings College Hospital
London
Liverpool Cardiothoracic Centre
Liverpool
Manchester Royal Infirmary
Manchester
New Cross Hospital
Wolverhampton
Data on HOSPITAL outcome
(2004 data 43 of 77 sites)
Northern General Hospital
Sheffield
Northwick Park Hospital
Harrow
Nottingham City Hospital
Nottingham
Papworth Hospital
Cambridge
Queen Elizabeth Hospital
Birmingham
Royal Brompton Hospital
London
Royal Cornwall Hospital
Truro
Royal Devon & Exeter Hospital
Exeter
Royal Sussex County Hospital
Brighton, Sussex
Sandwell District General Hospital
West Bromwich
Southampton General Hospital
Southampton
St George's Hospital
London
St Mary's Hospital
London
St Thomas' Hospital
London
Taunton & Somerset
Taunton
Data on HOSPITAL outcome
(2004 data 43 of 77 sites)
Torbay Hospital
Torquay
Walsgrave Hospital
Walsgrave
Aberdeen Royal Infirmary
Aberdeen
Edinburgh Royal Infirmary
Edinburgh
Glasgow Western Infirmary
Glasgow
Western General Hospital
Edinburgh
Morriston Hospital
Swansea
University Hospital of Wales
Cardiff (limited data)
Royal Victoria Hospital
Belfast
BMI Priory Hospital
Edgbaston
BUPA Hospital Southampton
Southampton
Harley Street Clinic
London
London Bridge Hospital
London
Some additional centres have provided CCAD data but not form C
Data on HOSPITAL outcome
(2004 data 35 of 77 sites)
Hospital Outcome 2004
Data from 43 centres
2004 data: Ludman
All Patients
No.
Success Partial
Success
Failed
43,570 92.8% 2.5% 3.6%
(86-99)
(0-7)
(0-9)
Repeat CABG
PCI
QMI
Death
(Range)
0.4% 0.26% 0.4% 0.75%
(0-4)
(0-1.1)
(0-2.6)
(0-2.2)
Hospital Outcome 2004
Data from 37 to 40 centres
Elective Patients
No.
Stable
Single Vessel
(no CTO)
Stable
Multivessel
(no CTO)
Single Vessel
CTO
Multivessel
Inc. CTO
14215
5597
Success Partial Repeat
Success
PCI
QMI
Death
(Range)
1.5%
0.2%
0.2%
0.3%
0.16%
(87-100)
(0-9)
(0-2)
(0-1)
(0-3)
(0-1.3)
0.4%
0.31%
(0-5)
(0-4)
0%
0.13%
(0)
(0-2.8)
93.0% 3.5%
(0-10)
0.3% 0.31%
(0-8)
(0-2.5)
69.5% 5.8% 0.24% 0.5%
(37-100)
1589
CABG
95%
(52-100)
1591
2004 data: Ludman
72%
(0-100)
(0-63)
(0-4.5)
(0-6.3)
17.8% 0.27% 0.37% 0.45% 0.96%
(0-100)
(0-7)
(0-9)
(0-6)
(0-10)
All Elective Cases – Overall MACE
22,992
0.25%
0.24%
(0-1.3)
(0-1.7)
Hospital Outcome 2004
Data from 34 to 37 centres
2004 data: Ludman
Patients with previous bypass grafts
Patients treated for restenosis
No.
CABG pts
Restenosis
Success
Partial
Success
Repeat
PCI
2486 87.5% 3.5%
0.19%
(29-100)
(0-4)
(0-15)
1668 91.7% 3.2%
0.35%
(50-100)
(0-4)
(0-17)
Does not account for clinical syndrome
CABG patients includes Rx of native and grafts
CABG
QMI
Death
(Range)
0.08% 0.46% 0.52%
(0-1.1)
(0-7)
(0-5)
0.16% 0.49% 0.52%
(0-4)
(0-14)
(0-8)
Hospital Outcome 2004
Data from 28 to 30 centres
2004 data: Ludman
Patients Rx for acute vessel closure
No.
Acute
closure
199
Success
Partial
Success
Repeat
PCI
CABG
Q MI
87.7% 1.2% 3.8% 2.0% 6.4%
(0-100)
(0-25)
(0-100)
Equivalent to SAT rate 0.32% - likely underestimate
(0-50)
(0-100)
Death
(Range)
2.3%
(0-37)
Hospital Outcome 2004
Data from 36 to 38 centres
2004 data: Ludman
UA and NSTEMI
No.
Success
Partial
Success
Repeat
PCI
CABG
Q MI
Death
(Range)
UA /
14,436 93.5% 2.5% 0.54% 0.21% 0.4% 0.75%
NSTEMI
(86-100)
(0-6)
(0-5)
(0-2)
(0-3)
(0-2.9)
Includes all classified as treated for UA and post MI angina (stable and unstable)
Hospital Outcome 2004
Data from 30 to 32 centres
2004 data: Ludman
Patients Rx for STEMI
No.
Primary
PTCA
1146
Rescue
PTCA
984
Re-MI
PTCA
414
Shock
259
Success Partial Repeat CABG
Success PCI
re-MI
Death
(Range)
87.2%
4.2%
1.1%
3.5%
0.6%
2.6%
(0-100)
(0-17)
(0-20)
(0-100)
(0-6)
(0-13)
0%
3.5%
89%
6.9%
0.7%
0.5%
(50-100)
(0-96)
(0-6.7)
(0-7.7)
91.3%
1.8%
(67-100)
(0-15)
(0-50)
(0-7)
67.3%
7.1%
1.5%
1.1%
1.0%
34.0%
(0-100)
(0-50)
(0-14)
(0-14)
(0-20)
(0-100)
2.1% 0.34%
(0-50)
0%
3.8%
(0-20)
Summary: In Hospital Mortality
Risk Stratified by Syndrome
(Data from approx 43,000 patients)
2004 data: Ludman
6
5
4
3.5
3.5
%3
2003
2004
2
1
0.75
0.89
0.24
0
All
Elective
UA /
Primary
NSTEMI
PCI
Rescue
In Hospital Mortality by Syndrome
(Data from approx 43,000 patients)
2004 data: Ludman
40
35
30
25
% 20
2003
2004
15
10
5
0
All
Elective
UA / Primary Rescue Shock
NSTEMI PCI
Emergency CABG by Syndrome
(Data from approx 43,000 patients)
2004 data: Ludman
2.6
2
1.1
U
A/
k
Sh
oc
M
I
0.5 0.34
R
e-
El
ec
tiv
e
N
ST
EM
I
SA
T
PP
TC
A
R
es
cu
e
0.26 0.25 0.21
Al
l
5
4.5
4
3.5
3
% 2.5
2
1.5
1
0.5
0
2003
2004
Late Events post Discharge
• BCIS - CCAD
BCIS / CCAD project
The Vision
Hospital 1
encryption
Hospital 2
encryption
Internet
Hospital 3
.
.
encryption
Hospital n
encryption
CCAD Server
BCIS / CCAD project
The Vision
Hospital 1 v All Others
Hospital 1
encryption
Hospital 2 v All Others
Hospital 2
encryption
Internet
Hospital 3
.
.
encryption
Hospital n
encryption
CCAD Server
BCIS / CCAD project
The Vision
Crosslink (NHS No.)
BCIS
SCTS
MINAP
EP / ICD
Pacing
ONS tracking
Advanced Analysis
CCAD Server
Risk stratified
Appropriateness
Process
Outcome
Device monitoring
etc.
Publication strategy
Patient outcome
Downloading to CCAD
September 2005
21 Centres
Birmingham Heartlands Hospital
St Bartholomew's Hospital
Freeman Hospital
St Peter's Hospital
Glenfield Hospital
Torbay Hospital
James Cook University Hospital
Yorkshire Heart Centre
John Radcliffe Hospital, Oxford
Bradford Royal infirmary
King Edward VII, Midhurst
Royal Bournemouth
Kings College Hospital
Hemel Hempstead
London Chest Hospital
University Hospital Wales
Queen Elizabeth Hospital, B’ham
Harley Street clinic
Royal Devon & Exeter Hospital
London Bridge Hospital
Southend Hospital
Some Data to CCAD
September 2005
Total 28 Centres
North Hampshire Hospital
St Thomas' Hospital
Victoria Hospital
Walsgrave Hospital
Wythenshawe Hospital
Harefield Hospital (imminent)
Bristol Royal Infirmary
NO Data to CCAD
September 2005
26 Centres
Birmingham City Hospital
Liverpool CTC
Royal Cornwall Hospital
Castle Hill / Royal Hull Hospital
Manchester Royal
Royal Free Hospital
Cheltenham General Hospital
New Cross Hospital
Royal Sussex County
City General Hospital
Northern General Hospital
Sandwell District General
Derriford Hospital
Northwick Park Hospital
Southampton General
Eastbourne Hospital
Nottingham City Hospital
St George's Hospital
Hammersmith Hospital
Papworth Hospital
St Mary's Hospital
Heart Hospital (UCLH)
Royal Berkshire and Battle
Taunton & Somerset
Royal Brompton Hospital
Morriston
Battle Hospital (Royal Berkshire)
Birmingham City Hospital
Birmingham Heartlands Hospital
Bristol Royal Infirmary
Bradford Royal Infirmary
Cheltenham General Hospital
City General Hospital
Derriford Hospital
Eastbourne Hospital
Freeman Hospital
Glenfield Hospital
Hammersmith Hospital
Harefield Hospital
Heart Hospital
Hemel Hempstead
Hull Royal and Castle Hill Hospital
John Radcliffe Hospital
Kings College Hospital
King Edward VII
Liverpool Cardiothoracic Centre
London Chest Hospital (submitted under Barts)
Manchester Royal Infirmary
New Cross Hospital
North Hampshire Hospital
Northern General Hospital
Northwick Park Hospital
Nottingham City Hospital
Papworth Hospital
Queen Elizabeth Hospital
Royal Brompton Hospital
Royal Bournemouth General
Royal Cornwall Hospital
Royal Devon& Exeter Hospital
Royal Free Hospital
Royal Sussex County Hospital
Sandwell District General Hospital
Southampton General Hospital
St Bartholomew's Hospital
St George's Hospital
St Mary's Hospital
St Peter's Hospital
St Thomas' Hospital
Taunton & Somerset
The James Cook University Hospital
Torbay Hospital
Victoria Hospital
Walsgrave Hospital
Wythenshawe Hospital
Yorkshire Heart Centre (Leeds General Infirmary)
Southend Hospital
3-D Line 51
3-D Line 52
Morriston Hospital
University Hospital of Wales
3-D Line 55
3-D Line 56
BMI Alexandra Hospital
BMI Park Hospital
BMI Priory Hospital
BUPA Cambridge Lea Hospital
BUPA Hospital Bristol
BUPA Hull and East Riding
BUPA Hospital Leeds
BUPA Hospital Leicester
BUPA Hospital Southampton
Capio Yorkshire Clinic
Cromwell Hospital
Harley Street Clinic
Leeds Nuffield Hospital
London Bridge Hospital
London Independent Hospital
St Anthony's Hospital
Wellington Hospital
Monthly CCAD data
Jan 2004 to Sept 2005
250
200
Jan
150
A pril
July
100
Oct
Jan
A pril
50
July
0
Total Data in CCAD
to Sept 2005
The James Cook University Hospital
Queen Elizabeth Hospital
Freeman Hospital
Yorkshire Heart Centre (Leeds
Birmingham Heartlands Hospital
London Chest Hospital
Victoria Hospital
Royal Brompton Hospital
King Edward VII
Glenfield Hospital
Harley Street Clinic
Kings College Hospital
St Bartholomew's Hospital
London Bridge Hospital
Bristol Royal Infirmary
Royal Bournemouth
Torbay Hospital
John Radcliffe Hospital
St Peter's Hospital
Royal Devon& Exeter Hospital
Walsgrave Hospital
Southend Hospital
Bradford Royal Infirmary
University Hospital of Wales
St Thomas' Hospital
North Hampshire Hospital
Hemel Hempstead
Harefield Hospital
0
1000
2000
3000
4000
5000
Tracking via CCAD
• Data completeness
• NHS numbers
– National Average 63%
– MINAP
87%
– SCTS
83%
24,073
PCI Procedures
15,250
Successful ONS tracking
Length of follow-up
(tracking performed July 2005)
CCAD
Median = 362 days
Successfully tracked cases
by year of procedure
10,000
9,000
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
2000
2001
2002
2003
2004
2005
Survival after Any PCI
(tracking performed July 2005)
In Hospital †:
Subsequent †:
0.61%
3.0%
CCAD
Approx 1.7% pa
Survival after Elective PCI
(tracking performed July 2005)
CCAD
Approx 1 % pa
2005
Survival after PCI for UA / NSTEMI
by Procedure Urgency
CCAD
urgent
salvage
emergency
Survival after PCI
All Shock
CCAD
No shock
shock
Survival after PCI for ACS
STEMI v NSTEMI / UA
CCAD
Non-STEMI
STEMI
p<0.0001
Shock excluded
(tracking performed July 2005)
Survival after PCI for ACS
STEMI v NSTEMI / UA
CCAD
Non-STEMI
STEMI
p<0.0001
Shock excluded
(tracking performed July 2005)
Survival after PCI for ACS
STEMI v NSTEMI / UA v Shock
CCAD
Non-STEMI
STEMI
Shock
(tracking performed July 2005)
Admission with ACS after PCI
(any PCI indication)
Patients with an exit diagnosis of ACS
CCAD
(tracking performed July 2005)
Re-admission with ACS after PCI
STEMI v NSTEMI v Shock
CCAD
Non-STEMI
STEMI
Shock
p=n.s.
Patients with an exit diagnosis of ACS
(tracking performed July 2005)
Event free survival after PCI
All Cases
CCAD
Events: death, ACS admission, redo PCI, cardiac surgery
87% 1 yr
83% 2 yr
Event free survival after PCI
Events: death, ACS admission, redo PCI, cardiac surgery
Stable
ACS: non-STEMI
ACS: STEMI
Shock
CCAD
Summary
77 PCI centres in UK
1050 PCI pmp in UK
Cath : PCI = 31.3%
PCI : CABG = 2.5 : 1
MACE
• BCIS – CCAD
– A new dawn
PCI per million
PCI Procedures
1200
80000
62,780
1000
1050
70000
53,261
894
800
60000
50000
600
40000
30000
400
20000
200
10000
0
0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
PCI Procedure Numbers
– Stable syndromes
• mortality 0.24%, CABG 0.25%
– UA / NSTEMI
• Mortality 0.75%, CABG 0.21%
PCI per million
•
•
•
•
•