bcis audit returns of interventional procedures 2000
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BCIS Audit Returns of Interventional Procedures 2000. Southampton, October 2001. Mark de Belder BCIS UK National Audit Officer on behalf of Council of the British Cardiovascular Intervention Society. UK Intervention Centres. UK Interventional & Diagnostic Centres 2000. - PowerPoint PPT PresentationTRANSCRIPT
BCIS Audit Returns of Interventional Procedures 2000
Mark de BelderBCIS UK National Audit Officeron behalf of Council of the
British Cardiovascular Intervention Society
Southampton, October 2001
UK Intervention CentresYear No. Centres1991 521992 521993 531994 541995 541996 531997 581998 611999 632000 66
UK Interventional & Diagnostic Centres 2000
No. No Dataon Caths
(%)
Caths(% oftotal)
PCIs(% oftotal)
NHSInterventional
49 9(18%)
85,030(69%)
30,916(92%)
PrivateInterventional
17 4(24%)
8,575(7.0%)
2,736(8.1%)
Diagnosticonly
63 7(11%)
29,700(24%)
0
TOTAL 131 - 123,305 33,652
3.5 caths for every 1 PCI in Intervention centres (1.2-82) (3.51 NHS, 3.73 Private)
Making assumptions about no. of caths done in centres not reporting,estimated caths in UK approx 145,000 = 4.3 caths/PCI
Centres providing NO DATA
None!
Centres providing NO or MINIMAL data on Centre Description Form (A)
Harefield Edinburgh Royal Infirmary Sheffield (Ayrshire & Arran) Cromwell Bristol BUPA
Centres providing NO or MINIMAL DATAon Minimum Data Form (B)
No data Harefield BUPA Bristol
Minimal Data Birmingham QEH Yorkshire Ht Centre Sheffield
Centres with MINIMAL or NO DATAon Outcome Form (C) Belfast City City, Birmingham Harefield Yorkshire Heart Centre UH Wales, Cardiff London Chest Manchester RI John Radcliffe, Oxford Royal Brompton Northern, Sheffield St Bartholomew’s
St Mary’s Derriford, Plymouth Eastbourne
Wellington Ross Hall London Independent St Anthony’s The Priory, Birmingham Harley St Clinic BUPA Bristol BUPA Lea Cambridge
Centres with no HOSPITAL Outcome Data
Cath Lab Data Only Blackpool Edinburgh Western Wythenshawe Morriston, Swansea
BMI Alexander, Manchester BUPA Leicester HCI Glasgow
Unspecified Data Belfast Royal Victoria Birmingham QE Bristol Royal Infirmary Hammersmith Hull Royal Infirmary Papworth Edinburgh Royal Infirmary Glasgow Western Glasgow Royal Infirmary Liverpool CTC Middlesex/UCH Freeman, Newcastle Glenfield, Leicester Hairmyres
Unspecified DataBUPA LeedsLondon BridgeCromwellYorkshire Heart ClinicPark, Nottingham
Volume of procedures in NHS CentresTotal number of procedures per annum
0
1
2
3
4
5
6
7
8
<10
0
-200
-300
-400
-500
-600
-700
-800
-900
-100
0
>10
00
1999
2000
Total 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
2000 66 33,652 590 20
PCI Rates per million population (UK)
0
100
200
300
400
500
600
'85
'88
'90
'92
'94
'96
'98
'00
PCI vs Isolated CABG Rates (UK)Data from BCIS and SCTS Registry
0
5000
10000
15000
20000
25000
30000
35000
'91 '92 '93 '94 '95 '96 '97 '98 '99 '00
BCISSCTS
PCI: UK 1996-2000 vs Rest of Europe 1996/1998
0200400600800
100012001400160018002000
PCIs/million
Ita
UK
96
UK
97
UK
98
UK
99
UK
00
Sp
a
Fin
Gre
De
n
Sw
e
No
r
Au
st
Ne
th
Fra
Sw
i
Be
lg
Ge
r
1996
1998
No. of Consultant Interventionists in NHS Centres, 2000 data from 48 centres
0
1
2
3
4
5
6
7
8
No of Centres
1 2 3 4 5 6 7 8 9 10 11 21
No of Consultants/Centre
Average 5.5 / Centre
No of PCIs per Consultant in NHS Centres, 2000data from 48 centres
0
2
4
6
8
10
12
14
16
No of Centres
0-50 51-100 101-150 151-200 201-250 >250
No PCIs/Consultant
Average 125 / Consultant
All PCI Procedures Mortality 2000 data from 48 centres
Year 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
2000 48/66 24,323(33,652)
0.64 0-2.6
All PCI procedures2000 data from 41 centres
Year Total Vessels/case
Success % MI % Em.CABG
Mortality%
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
2000 20,939(33,652)
1.21 92 0.6 0.4 0.7
Stent procedures 1992 - 20002000 data from 61 centres
0102030405060708090
% of all PCIs
'92 '93 '94 '95 '96 '97 '98 '99 '00
Year
Stenting in different centres 1998-20002000 data from 61 centres
0
5
10
15
20
25
30
35
40
No. of Centres
31-40 41-50 51-60 61-70 71-80 81-90 >90
% Stented
1998
1999
2000
Impact of Stenting 1992-20002000 data from 40 centres
Year % Stented % PCI forRestenosis
% 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
2000 85 6.2 0.4
Stenting and the need for emergency CABG (2000 data from 40 centres)
0
10
20
30
40
50
60
70
80
90
'92 '93 '94 '95 '96 '97 '98 '99 '00
Year
%
0
0.5
1
1.5
2
2.5
%
% Stent
% Em.CABG
Stenting and procedures for restenosis
(2000 data from 40 centres)
0
10
20
30
40
50
60
70
80
90
'92 '93 '94 '95 '96 '97 '98 '99 '00
Year
%
0
2
4
6
8
10
12
14
%
% Stent
% Restenosis
PCI for Restenosis 1998 - 2000(2000 data from 40 centres)
0
5
10
15
20
25
No. of Centres
0-5 5.1-10 10.1-15 >15
% for Restenosis
1998
1999
2000
Stent Procedures 1992 - 20002000 data from 29 centres
1992 1993 1994 1995 1996 1997 1998 1999 2000
Elective 179 341 834 2,595 2,373 3,170(45%)
(7.5-100)
3,376(56%)(0-100)
7,244(64%)
(19-100)
9,365(75%)
(19-100)
Sub-optimal 2,166 2,759(39%)(0-98)
2,238(37%)(0-100)
3,909(31%)(0-83)
2,773(22%)(0-79)
Bail-out 140 286 1,086 1,269 429 975(14%)(0-52)
410(6.8%)(0-27)
538(4.8%)(0-35)
299 (2.4%)(0-35)
% Bail-out 44 46 44 33 16 14 6.8 4.8% 2.4%
Total StentProcedures
319 660 1,937 4,574 9,165 7,096of
11,905
6,024of
12,507
11,691of
19,769
12,437of
27,057
Stent use 1997 - 2000(2000 data from 29 centres)
0
10
20
30
40
50
60
70
80
% of all stented cases
ES SOS BOS
Stent use
1997199819992000
ReoPro in different centres 1999 - 20002000 data from 61 centres
0
5
10
15
20
25
30
No. of Centres
0_10
11_2
0
21_3
0
31_4
0
41_5
0
51_6
0
61_7
0
71_8
0
81_9
0
% ReoPro
ReoPro used in 22% of cases in 200050 cases using eptifibatide or tirofiban reported
ReoPro use 1997 - 20002000 data from 61 centres
0%
5%
10%
15%
20%
25%
% use
1997 1998 1999 2000
Year
Other procedures 2000 - 1
PTCRA DCA TEC Laser CB Thromb
Centres 18+
4-
0-
3+
33++
13+
No. 119+
12-
0-
34+
372+
53*++
Mean 6.6-
3-
0-
11+
11-
4.1+
Range 1-50 2-4 - 1-31 1-73 1-31
+, =, - : increase, no change or decrease compared to 1999* mainly Xsizer NB Only 2 reported to voluntary registry
Other procedures 2000 - 2
BrachyRx P(D)MR IVUS Angio-scopy
Groinclosure*
Centres 5+
0-
26-
3+
37+
Number 57++
0-
341-
14+
5938++
Mean 11 - 13-
4.7 160+
Range 3-21 - 1-50 2-6 1-766
+, =, - : increase, no change, or decrease compared to 1999* Mainly Angioseal
Other Procedures 2000 - 3
MVplasty AVplasty PVplasty TVPlasty Coart/Re-coarct
Centres 33+
7-
5--
1=
5+
No. 199--
13-
13-
1=
10+
Mean 6-
1.9=
2.6+
- 2+
Range 1-26 -
1-3 1-5 -
- 1-4
+, =, - : increase, no change, or decrease compared to 1999
Other Procedures 2000 - 4PDA ASD* PFO* VSD
Centres 7+
20+
6+
0=
No. 12+
190++
19+
0=
Mean 1.7=
9.5+
3.2+
-
Range 1-2 1-32 1-9 -
+, =, - : increase, no change or decrease compared to 1999* Some centres give combined data for ASD/PFO closure
Other Procedures 2000 - 5
Renal Sub-clavian
Pulm.artery
Aorta SVC Carotid
Centres 1=
1=
0-
0-
3+
1+
No. 4=
1=
0-
0-
4=
1+
Mean - - - - 1.3 -
Range - - - - 1-2 -
+, =, - : increase, no change, or decrease compared to 1999
Other procedures 2000 - 6
FBremoval
Emboln. Pericard. PressureWire
FlowWire
SeptalAbln.
Embolis’nProtection
Device
Centres 9+
9+
1=
2=
1=
1=
4+
Number 15+
26+
2-
31-
2-
7+
16+
Mean 1.7 2.9 - 15 - - 4
Range 1-5 1-9 - 13-18 - - 1-10
+, =, - : increase, no change, or decrease compared to 1999
Centres providing complete or near complete data on Hospital Outcome 2000 (18)
Aberdeen Birmingham Heartlands Guy’s & St Thomas’s King’s College Hospital Walsgrave, Coventry Royal Free Hospital Stoke City General Southampton St George’s
James Cook UH, Middlesbrough Nottingham City Hospital Royal Devon & Exeter KE VIIth, Midhurst Sandwell Hospital Royal Sussex County, Brighton Ayrshire & Arran RCH Truro
Heart Hospital
Hospital Outcome 2000All patientsData from 18 centres
No.(centres)
Success PartialSuccess
Failed RepeatPCI
CABG MI Death(Range)
8960(18)
92% (86-100)
1.6% (0-2.1)
3.9%(0-7.9)
0.5%(0-0.9)
0.5%(0-9.1)
0.8%(0-3.1)
1.1%(0-2.7)
Hospital OutcomeDeath (with 95% CI) Data from 18 centres
00.5
11.5
22.5
33.5
44.5
5
0 5 10 15 20
Hospital OutcomeFreedom from MACE rates (with 95% CI) Data from 18 centres
82
84
86
88
90
92
94
96
98
100
0 5 10 15 20
Hospital OutcomeEm. CABG (with 95% CI) Data from 17 centres
012345
6789
10
0 5 10 15 20
Hospital OutcomeFailed Procedures (with 95% CI) Data from 18 centres
012345
6789
10
0 5 10 15 20
Examples of different case-mix
Centre ElectiveNo CTO
CTO cases UA Shock Non-shockMI cases
Post MI
1(n=343)
29% 3.8% 31% 2.3% 11% 22%
2(n=963)
44% 7.5% 27% 0.3% 6.3% 16%
3(n=749)
35% 2.9% 18% 2% 18% 24%
4(n=131)
77% 12% 11% 0% 0% 0%
5(n=10)
0% 0% 50% 0% 20% 30%
Hospital Outcome 2000Elective patients
No.(centres)
Success PartialSuccess
RepeatPCI
CABG MI Death(Range)
StableSingle Ves(no CTO)
3448(15)
96% (88-97)
0.2% (0-1.2)
0.3%(0-1.2)
0.3%(0-1.1)
0.5%(0-1.6)
0.12%(0-0.5)
StableMultivessel(no CTO)
912(14)
92%(85-100)
3.9%(0-6.7)
0.2%(0-0.8)
0.3%(0-1.4)
0.8%(0-1.5)
0.5%(0-3.9)
Single VesCTO *
407(14)
64%(45-91)
1.0%(0-5.3)
0.2%(0-1.4)
0.2%(0-1.0)
0.5%(0-2.0)
0%
MultivesselInc. CTO *
241(13)
80%(40-100)
14%(0-37)
0% 0% 0.4%(0-2.2)
0.4 %(0-2.9)
* does not account for clinical syndrome
Hospital Outcome 2000Patients with previous CABG and those treated for restenosis
No.(centres)
Success PartialSuccess
RepeatPCI
CABG MI Death(Range)
CABG pts * 907(14)
90%(80-97)
2.1%(0-8.9)
0.3%(0-2.2)
0.2%(0-2.9)
1.3%(0-6.7)
1.0%(0-4.4)
Restenosis * 405(15)
93%(79-100)
1.0%(0-1.9)
0.7%(0-2.9)
1.5%(0-100)
0.5%(0-20)
0.7%(0-3.1)
* does not account for clinical syndrome
Hospital Outcome 2000Unstable angina
No.(Centres)
Success PartialSuccess
RepeatPCI
CABG Q MI Death(Range)
Single VesUA
1945(17)
93%(67-100)
0.6%(0-2.7)
0.8%(0-4.2)
0.6%(0-33)
0.6%(0-3.3)
0.9%(0-1.6)
MultivesselUA
488(14)
90%(83-100)
6.8%(0-15)
0.8%(0-2.6)
0.2%(0-5)
0.4%(0-1.5)
0.6%(0-4.2)
Hospital Outcome 2000Acute closure
No.(Centres)
Success PartialSuccess
RepeatPCI
CABG Q MI Death(Range)
Acuteclosure
68(12)
81%(40-100)
1.5%(0-20)
4.4%(0-100)
1.5%(0-20)
8.8%(0-100)
10%(0-100)
Hospital Outcome 2000Acute MI patients
No.(Centres)
Success PartialSuccess
RepeatPCI
CABG re-MI Death(Range)
PrimaryPTCA
163(13)
86%(60-100)
0.6 %(0-7.7)
1.2%(0-20)
0.6 %(0-5)
4.0 %(0-17)
4.9%(0-40)
SalvagePTCA
242(15)
88%(59-100)
1.7%(0-7.4)
1.2%(0-5.9)
1.7%(0-10)
1.2%(0-10)
6.2%(0-26)
Re-MIPTCA
166(10)
87%(0-100)
3%(0-6)
2.4%(0-10)
2.4%(0-6.3)
1.2%(0-100)
6%(0-13)
Shock 92(13)
55%(0-100)
1.0%(0-20)
4.0%(0-100)
2.0%(0-40)
1%(0-6.3)
39%(19-100)
Hospital Outcome 2000Post MI patients
No.(Centres)
Success PartialSuccess
RepeatPCI
CABG Re-MI
Death(Range)
Post MI UA 986(14)
94%(86-100)
1.2%(0-5.6)
0.6%(0-2.8)
0.9%(0-2.5)
0.9%(0-5.3)
1.0%(0-2.8)
Post MIStable/+ETT
319(8)
95%(88-100)
0.9%(0-5.9)
0% 0.6%(0-1.9)
0.9%(0-1.7)
0.3%(0-1)
ALL MIPatients
1498(15)
89%(67-95)
1.0%(0-5)
1.1%(0-4.3)
1.2%(0-5.5)
1.2%(0-6.5)
5.0%(0-20)
Hospital OutcomeElective Single Vessel PCI (no CTO)Success (Freedom from MACE) rates (with 95% CI) Data from 15 centres
82
84
86
88
90
92
94
96
98
100
0 5 10 15 20
Hospital OutcomeElective Single Vessel PCI (no CTO)Mortality rates (with 95% CI) Data from 15 centres
00.20.40.60.8
1
1.21.41.61.8
2
0 5 10 15 20
Hospital OutcomeCardiogenic Shock PCI (Primary or Rescue)Mortality rates (with 95% CI) Data from 15 centres
01020304050
60708090
100
0 5 10 15 20
1 of 1
Comparison of data reported from a single centre with other contributing centres
Syndrome No Success orPartial Succ.
CBG MI or re-MI Death
Elective1V
191 183 (96%) 0 0 0
No CTO 3257 3137 (96%) 10 (0.3%) 18 (0.6%) 4 (0.1%)
All Unstable 137 132 (96%) 0 0 0
Angina 2296 2158 (94%) 13 (0.6%) 14 (0.6%) 20 (0.9%)
Rescue 50 47 (92%) 0 0 2 (4%)
PCI 209 170 (89%) 4 (2.1%) 3 (1.6%) 13 (6.8%)
All ShockPCI
15 10 (67%) 0 0 5 (33%)
(Primary &Rescue)
77 42 (54%) 2 (3%) 1 (1.4%) 31 (40%)
BCIS/CCAD UpdateCCAD
Questionnaire DoH Meeting, November 2001 NHSIA Meeting to revisit datasets Phased participation over 2002? Pressure on Trusts/Commissioners
BCIS/CCAD UpdateData SetParallel Projects
A = Centre B = Bean Count C = Outcome data by Syndrome
BCIS New Technologies Group - Registries
BrachytherapyEndicor X-sizer
BCIS/CCAD UpdateConclusions
Continued growth in PTCA (84% stented, 22-23% with GP IIb/IIIa) but still lagging behind European/American centres
Still a lot of low volume operators Expansion of PCI activity appears to have been
achieved in 2 ways– higher numbers of PCIs performed in a small number
of hands– increased numbers of operators (presumably attending
consultants from other hospitals)
BCIS/CCAD UpdateConclusions
Data submission still incomplete - questionnaire to establish what is needed.
Encouraging noises from DoH re CCAD BCIS will continue current data collection system
even for those units who start to use CCAD Current system provides some means of bench-
marking New Technologies Registries may not be
effective on a voluntary basis (CCAD could overcome this)
Clinical Governance
Individual outcomes ‘to be public within a year’Hospital Doctor 18th October 2001
“DoH considering a proposal from Dr Foster”