National Cardiac Audit Programme (NCAP) 2019 Annual Report out today!


The National Cardiac Audit Programme’s 2019 annual report (2017/18 data) details key information about cardiovascular services and patient outcomes in England and Wales. The report launched today by the National Institute for Cardiovascular Outcomes Research (NICOR), the national cardiac audit provider hosted at Barts Health NHS Trust, also highlights quality improvement opportunities by recommending actions for clinicians, service managers and commissioners of healthcare services.

Nationally the report shows that there has been particular progress in areas relating to the specialist care of congenital heart disease, heart failure and heart attack patients in the last few years.

* The overall rate of antenatal detection of fetal cardiovascular abnormalities which require intervention in the first year of life has risen to over 50%, with particularly good improvements in complex conditions. The report suggests reviewing staffing levels, the availability of the necessary ultrasonography equipment and ensuring that obstetric sonography staff are receiving appropriate education and training.

* 96% of patients admitted with NSTEMI (lower-risk) heart attacks and 82% of those admitted with heart failure were seen by specialist teams in 2017/18 (all STEMI (high-risk) heart attack patients undergoing emergency treatment are necessarily managed by interventional cardiologists on admission to hospital). Hospitals are recommended to ensure that all such patients have equal access to specialist care, either by admitting more patients to a cardiology ward or by using specialised nursing cardiac ‘outreach’ teams to support patients on other types of wards.

The report paints a more challenging picture of timeliness of care, with large variations between hospitals for time to treatment of heart attacks with angioplasty (PCI) and coronary artery bypass graft surgery, as well as diagnosis of non-emergency heart attack cases by angiography.

* The median ‘call-to-balloon’ time to treatment of heart attacks with emergency percutaneous coronary intervention (primary PCI) has increased by 9 minutes over the last 3 years. There are also sizeable variations between hospitals in the proportion of patients that undergo treatment within 60 minutes of admission. There are Quality Improvement actions for hospitals, ambulance services and STPs/local health systems to address this, particularly around the logistics of admitting patients. Patients themselves can assist by calling for an ambulance rather than attempting to get themselves to hospital.

* Times to coronary artery bypass graft (CABG) surgery have not improved significantly at a national level. Just over a third of patients have the procedure within 7 days of the diagnostic angiogram. Hospitals are advised to ensure that at least 75% of patients requiring urgent CABG receive this treatment within 7 days of the angiogram which, in most circumstances, implies the patients should undergo the procedure as an in-patient.

Geographical variation is also apparent when considering whether evidence-based treatment (such as that supported by national and international guidelines) is delivered equitably to patients. This is marked in the case of heart failure patients being discharged on the recommended package of three medicines. The situation is more encouraging in the case of percutaneous coronary interventions. Advances in practice such as radial access and the use of modern drug-eluting stents have meant that treatment is safer and more effective. There has been a rise in elective PCI performed as a day-case.

* Well over half of hospitals are not achieving the target of offering the triple package of heart failure medicines to at least 60% of patients. These hospitals should especially look to increase the use of mineralocorticoid receptor antagonist (MRA) drugs.

* Use of day-case angioplasty is growing. There is, though, extremely wide variation between hospitals, with some centres performing day-case angioplasty in almost all elective cases, and some where almost all patients are kept in overnight following their procedure. Hospitals should aim to offer day-case angioplasty to at least 75% of their elective cases.

Professor John Deanfield, Director of NICOR, said:

This report builds on last year’s first National Cardiac Audit Programme report, which brought together 5 major national cardiovascular audits for the first time in a single report. The programme has analysed data from over 300,000 patients. This 2019 annual report, supported by UCL Partners, covers the fields of Congenital Heart Disease, Heart Attack, Percutaneous Coronary Interventions (PCI), Adult Surgery and Heart Failure. The results of the National Cardiac Rhythm Management audit for 2017/18 will be brought into next year’s report. Hospitals are provided with their own data for each metric and can see how they compare with others. These results help determine national quality improvement aims for clinicians, service managers and commissioners.

Access the full analyses here