pci models: gloucestershire nick west consultant cardiologist
TRANSCRIPT
PCI Models: Gloucestershire
Nick West
Consultant Cardiologist
MY CONFLICTSOF INTEREST ARE:
Advisory Board: Nycomed, Astrazeneca, Schering-Plough
Speaker Fees: Nycomed, Astrazeneca, Schering Plough, MSD
Sponsorship: Boston Scientific, Nycomed, Medtronic, Abbott Vascular
Research Grants: Bristol-Myers Squibb
Glos Hosps NHS Foundation Trust
• 650,000 population
• 2 DGHs
• 2 Cath labs
• 3 Interventionalists
• Remote from Tertiary centres
Who should go to a surgical centre?
Viewpoints: Patients Trusts Cardiologists
A local service
0
100
200
300
400
500
600
2002/03 2003/04 2004/2005 2005/2006 2006/2007
Out of county
In-county
PCI in Gloucestershire:Inpatient vs. Elective work.
Cas
es/y
ear
(n)
Possible issues
Out-of-hours/on-callSpecialist techniques/devices‘High risk’ casesResearch studies
Out of hours/on-call
Can your service offer PCI 24/7?Are you geared up for emergencies?How many interventionalists are there?Is there an on-call rota?Do the rest of the cath lab staff want this?Is it cost-effective?
Network solutions
What is ‘high risk’?
0
100
200
300
400
500
600
2002/03 2003/04 2004/2005 2005/2006 2006/2007
Out of county
Urgent PCI
Elective PCI
PCI in Gloucestershire:Inpatient vs. Elective work.
Cas
es/y
ear
(n)
1.2
1.6
1.3
0.0
0.5
1.0
1.5
2.0
CGH RBH NWQIP
How do we measure up?
1.2
0.4
1.6
0.4
1.3
0.0
0.5
1.0
1.5
2.0
CGH RBH NWQIP
Inh
osp
ital
MA
CE
(%
)
Grayson et al. Heart 2006; 92: 658-663
Research Studies
Should offsite centres be allowed to join in?
UC
20
06
03
56
5 E
E. D
ata
and
im
ag
es
on fi
le a
t M
ed
tronic
Inc.
CE M
ark
ed
. N
ot
availa
ble
for
use
or
dis
trib
uti
on in t
he U
SA
.
Use
, re
pro
duct
ion a
nd
dis
trib
uti
on o
nly
by p
erm
issi
on o
f M
ed
tronic
, In
c.
E-5 Registry: the ‘Real World’E-5 Registry: the ‘Real World’
Final UK recruitment:Final UK recruitment:
Cheltenham GeneralCheltenham General 100 100Leeds GeneralLeeds General 6565Royal Victoria, BelfastRoyal Victoria, Belfast 5151St. Georges, London St. Georges, London 4646James Cook, M’boro James Cook, M’boro 3636QE, BirminghamQE, Birmingham 3535Derriford, Plymouth Derriford, Plymouth 1818Barts, LondonBarts, London 1414Nottingham City Nottingham City 1313Walsgrave, Coventry Walsgrave, Coventry 1313London Chest London Chest 1212
PC Biomimetic polymerPC Biomimetic polymerReduced platelet depositionReduced platelet deposition
Rapid and complete drug deliveryRapid and complete drug deliveryHighly lipophillic limus analogueHighly lipophillic limus analogue
Noninflammatory responseNoninflammatory responseand rapid endothelializationand rapid endothelialization**
Possible issues
Out-of-hours/on-callSpecialist techniques/devices‘High risk’ casesResearch studies
?
X
X
X
Summary
Few good arguments to limit offsite work
Can we all live together happily ever after?
Acknowledgements
Rafe Chamberlain-WebberZafar KhanAll cath lab staff at CGH