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Category Archive: Adult Percutaneous Intervention

National Cardiac Audit Programme (NCAP) Report 2018 out today

Report out today highlights progress in cardiovascular care and makes recommendations for improvement

The National Cardiac Audit Programme’s annual report details key information about the safety and clinical effectiveness of cardiovascular services, and also patient outcomes in England and Wales. The report from the National Institute for Cardiovascular Outcomes Research (NICOR) recognises areas of clinical excellence that can be adopted across the NHS, identifies areas where care falls below expected standards and makes 16 important recommendations to improve patient outcomes.

Professor John Deanfield, Director of NICOR, explains: “This report is the first National Cardiac Audit Programme report, bringing together the 6 major national cardiovascular audits for the first time in a single report. The programme has analysed data from over 300,000 patients. This report has been supported by UCL Partners and includes the results of five of these audits, covering the fields of Congenital Heart Disease, Heart Attack, Angioplasty, Adult Surgery and Heart Failure. The results of the Cardiac Rhythm Management audit will be presented later in a separate 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.”

The full analyses, including hospital level data for all the sub audits, and a summary of the key messages and recommendations, can be accessed via NICOR’s website https://www.nicor.org.uk/national-cardiac-audit-programme/ from today, Thursday 22 November.

NAPCI – 2015 Annual Public Report

New figures demonstrate encouraging outcomes and process in the quality of interventional treatment of heart attacks in the UK which is good news for cardiac patients.

The latest report from the National Audit of Percutaneous Coronary Intervention (PCI) shows an increase from 26.9% to 80.5% in the use of a safer method of PCI (also called angioplasty, usually with stent insertion) between 2007 and 2015.

The PCI procedure, which involves inserting a tube or catheter into the patient’s arterial system to reach the blocked heart artery in order to improve blood flow, is associated with fewer complications if carried out through an artery in the wrist (the radial artery) rather than the femoral artery at the top of the leg. The significant increase has been seen in the use of this safer radial access procedure.

Peter Ludman, Consultant Cardiologist and Clinical Audit Lead said:

“The impressive increase in PCI procedures with radial artery access for the treatment of serious heart attacks ST-Elevation Myocardial Infarction (STEMI) shows that UK interventional cardiologists are keeping up to date with developments in their field and changing practice in response to evidence showing lower complication rates with this method.”

NICE quality standard [QS68] requires that patients presenting with ST-elevation myocardial infarction (STEMI, a major heart attack) receive emergency treatment within 90 minutes from arrival at a specialist heart centre. The audit, commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme managed by NICOR (National Institute for Cardiovascular Outcomes Research), found that 90.9% of patients being treated within that time frame in 2015, and this is similar to the standards achieved in the last 3 years. Reasons for missing the 90 minute treatment target can be the result of initial admission to a non-specialist heart centre and consequent transfer between hospitals, or clinical reasons such as the requirement in some for further investigations to be undertaken before treatment.

Ensuring patients are treated by healthcare staff with sufficient expertise is fundamental to providing excellent care for cardiac patients. The 2005 guidance from the British Cardiovascular Intervention Society (BCIS) and the British Cardiac Society (BCS) therefore recommends institutions carry out a minimum of 400 of these procedures per annum (ppa).

The audit also reports on patients with unstable angina and non-ST elevation Myocardial Infarction (nSTEMI). These patients are at risk of future cardiac events and require urgent but not immediate treatment.  Although NICE quality standard [QS68] sets a target for treatment to be delivered to nSTEMI patients within 72 hours, about half of all patients are waiting longer than recommended. This is an avoidable cause of prolonged length of in-hospital stay and increased treatment cost. As with patients who have STEMI, treatment delays are worse for patients who require transfer to another hospital for PCI treatment.

Peter Ludman continued:

“The audit shows a reassuring picture of PCI quality in the UK.  From 2014 to 2015 there was only a 0.5% increase in total PCI activity, bringing the total to 1,496 per million population (pmp).  Primary PCI is established across most of the UK as the default treatment for ST elevation MI and most centres deliver this emergency treatment in a timely manner.  Patients waiting for PCI having been admitted with a non-ST elevation myocardial infarct are still waiting much longer than recommended.  However there has been a further increase in the use of the radial artery for vascular access, and overall outcomes from PCI remain good.”

Other messages in the report include:

  • There remain long delays for patients waiting for PCI for non-ST elevation myocardial infarction, 2.5 days for those admitted direct to a PCI centre and 3.5 days for those initially admitted to another hospital.
  • Overall outcomes following PCI remain good and unchanged from the previous year.  Overall mortality was found to be about 2% to hospital discharge, and a stroke rate of 0.08%.
  • The report has made important recommendations to address the access issues with plans for more direct admission to specialist centres for both STEMI and non-STEMI patients.

Clinical Services Quality Measures: Consultation Launches Today

The overall objective of the NICOR cardiac audits is to provide information to enable those who receive, deliver and commission healthcare to measure and improve services.

Clinical Services Quality Measures are one of the ways we will provide this information in a timely manner and will allow ‘at-a-glance’ comparisons of similar services across the country. The work has been commissioned by NHS England, and the cardiac measures will initially focus on the treatment of patient with hearts attacks.

We are currently in the development phase and have identified a long list of measures. These measures will be used to measure a quality service and aim to answer the following questions:

Patients: Clinicians: Answered by:
 Was I given the best care?  Did I do the right things?  CSQM measures based on good practice criteria or standards.
 Has my health improved?  Am I helping to improve survival and reduce morbidity?  CSQM based on life mortality and morbidity rates.

We would like your help to ensure we have the right domains and indicators to answer these questions.

What are the measures?

The CSQM spreadsheet* provides a full list of measures that cover both STEMI and NSTEMI patients.

*If you have any problems accessing the spreadsheet file, please access this link

These are separated into two worksheets to reflect the different patient pathways for Heart attack patients:

1) Primary Percutaneous Coronary Intervention (pPCI) Centres (centres that treat over 20 patients per year)

2) Non primary PCI centres or centres performing less than 20 cases per year.

If you would like to provide feedback on both the pPCI and nonPCI centres you will need to complete both surveys:

  1. primary PCI CSQM survey
  2. non primary PCI CSQM survey.

We would very much appreciate whatever you are able to do, while recognising that you are busy and have many demands on your time. Your input is very valuable.

The consultation closes on July 31st 2016.

  • Further information  about the CSQM programme can be found on the NHS England website.
  • A summary and FAQs for the Cardiac Clinical Services Quality Measures is available here.

2015 Consultant Outcomes Publication – National Audit for Percutaneous Coronary Interventions

NAPCI – The National Audit of Percutaneous Coronary Intervention (PCI) is managed by National Institute for Cardiovascular Outcomes Research assesses percutaneous coronary intervention in the United Kingdom.

For the 3rd the audit publishes the analysis of each individual consultant PCI operator’s and hospital activity and outcomes in collaboration with British Cardiovascular Interventions Society (BCIS). Regular review of procedural outcomes is essential to assure, improve and maintain high standards of care for patients. We consider transparent reporting of outcome data after procedures to be a fundamental part of good clinical practice.

The results are available in two different formats via:

• Full reports in pdf format on the BCIS website

MyNHS (part of NHS Choices) website

For more information about the data please contact Lucia Gavalova: at l.gavalova[at]ucl.ac.uk

For all media enquiries, please contact Harry Dayantis:

E-mail: h.dayantis[at]ucl.ac.uk

Tel: 020 3108 3844

For further background on the COP programme, please visit Health Quality Improvement Partnership website.

National Audit of Percutaneous Coronary Interventions (NAPCI) 2014 Annual Public Report

The NAPCI assesses the process of PCI care and speed of the PCI delivery as well as the patient outcomes for example complication rates, or mortality.  Annually the audit publishes its results on the British Cardiovascular Intervention Society website supplemented by the lay summary of the findings – the latter being published today.

The latest audit findings include :

  • Although the number of PCIs performed in the UK has more than doubled over the last decade – from 44,913 PCI procedures (in 2002) to 92,589 performed in 2013 – the number appears to have levelled off over the last two years.
  • In 2013 emergency PCI to treat acute heart attacks continues to be delivered quickly – 79% of all patients were treated within 150 minutes of calling for professional help and 90% treated within 90 minutes of arriving at the PCI centre. This compares very favourably with international data.
  • Patients who need to be transferred between hospitals for primary PCI continue to have longer delays to treatment than patients admitted directly to a PCI centre. Transfer delayed treatment by about 40 minutes.
  • Delays in treating patients with NSTEMI have improved, but remain longer than recommended. In 2010 48 % were treated within 72 hrs of initial admission to hospital. This has risen to 55% in 2013.
  • BCIS and BCS recommend in their Recommendation for good practice and training recommend that centres undertake minimum of 400 procedures per year. The audit shows that 22% of centres performed less than 400 PCIs in 2013.
  • There has been a continued increase in the use of the radial artery instead of the femoral for access, and this may be one of the factors responsible for driving down complication rates. The audit notes variation between centres in the rates of the use of radial arterial access.

The report is available on the NICOR website.

2014 Consultant Outcomes Publication

MY NHS – NHS Choices has today published the consultant outcomes data for both the National Audit of Percutaneous Coronary Intervention (NAPCI) and the National Adult Cardiac Surgery Audit (NACSA).

NACSA – This data covers the reporting period 2010 – 2013. The data again shows very low overall mortality rates following adult cardiac surgery in the UK. The data is from 36 hospitals and 307 consultants who submitted data to the NICOR database during the reporting period.

NAPCI – The National Audit of Percutaneous Coronary Intervention (PCI) assesses percutaneous coronary intervention in the United Kingdom, and for the second year reports the volume of cases performed by operators and by PCI centres. It also describes their case mix and outcomes.

More information on the analyses can be found on the Society for Cardiothoracic Surgery and the British Cardiovascular Intervention Society websites.

For all media enquiries, please contact Harry Dayantis:

E-mail: h.dayantis@ucl.ac.uk

Tel: 020 3108 3844

For further background on the COP programme, please visit Health Quality Improvement Partnership website.

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