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Category Archive: Cardiac Rhythm Management

National Audit for Cardiac Rhythm Management Devices and Ablations 2016/17 Summary Report out today

Report out today shows an increase in pacemaker and defibrillator implants over time but highlights variability among centres and regions

The National Audit of Cardiac Rhythm Management, part of the wider National Cardiac Audit Programme, has published the 2016/17 Devices and Ablation report , providing important information about the safety and clinical effectiveness of cardiac rhythm management services, and also patient outcomes in England, Wales, Scotland and Northern Ireland.

Nationally, it shows that there has been a gradual increase in pacemaker implants over the last decade. However, this has now levelled off, a trend also seen with defibrillator (ICD and CRT-D) implants, which rose significantly after the publication of NICE guidelines recommending their use in 2014, but growth in new implant activity has slowed. There has been an increase in the proportion of CRT-D compared with ICD devices. The marked rise in catheter ablation procedures (20% growth between 2007/08 and 2011/12) has also slowed to only 4% between 2012/13 to 2016/17. The recent growth has mainly come from use of the technique in cases of atrial fibrillation. The data show considerable variation in implant and ablation rates at both a hospital and regional level. The report also shows significant variance in the need for repeat ablation procedures between hospitals. Centres are requested to improve data quality for some key fields to assist the audit programme in its aims to provide important feedback to hospitals.

The report, from the National Institute for Cardiovascular Outcomes Research (NICOR), and which is a supplement to the National Cardiac Audit Programme Report 2018 also makes some key recommendations to improve patient outcomes and data quality including the following:

  • Commissioners and Chief Executives are asked to consider whether pacemaker and ICD/CRT implant activity, and the total and complex ablation activity at the hospital level is in line with BHRS guidelines to ensure the skill of performing the procedure is maintained. If activity is below the guideline levels, particular vigilance for the appropriateness of procedures and their complications is recommended, and the sustainability of the service should be considered.
  • Medical Directors and Clinical Leads are requested to provide appropriate clinical support to the clinical audit teams. NICOR data show that higher level of clinical engagement with the clinical audit team is associated with better data completeness and data quality of the audit data. Each clinical audit should have an identified clinical lead assigned to support this activity.
  • Clinicians Performing CRM Device Procedures are recommended to oversee the entry of data for all procedures into the national audit, to ensure completeness and correctness. They are reminded that they are clinically responsible.
  • Clinical Audit Teams are advised to submit data as soon as possible after device and ablation procedures and on a quarterly basis at the very least. They are reminded that the NICOR standard for data submission is that each quarter’s data should be submitted by the end of the following quarter at the latest. Up to date data are associated with higher completeness and accuracy. Timely feedback will be provided to improve performance.

Professor John Deanfield, Director of NICOR, explains: “This report is the 12th National Cardiac Audit Programme report for implantable device procedures and the 10th for ablation procedures used in the management of abnormal cardiac rhythms. It describes recent activity in terms of three quality improvement themes: patient outcomes, safety and clinical effectiveness. This helps clinicians, service managers and national regulators identify priority areas for improvement.”

The full report and appendices, including interactive maps and reports for 187 implanting centres and 75 ablating centres in England, Wales, Scotland and Northern Ireland can be accessed via NICOR’s website

 

 

National Cardiac Rhythm Management Devices 2015/16 Annual Report now available

The 11th annual report for the National Cardiac Rhythm Management Devices Audit was published on 14th February 2017

The report presents the official record of CRM device procedures and quality issues related to the provision of CRM devices between 1st April 2015 and 31st March 2016.

The 2015/16 report shows a variation in implantation rates for pacemakers and defibrillators, nationally and in comparison to Europe. The report presents the official record of CRM devices procedures, quality issues related to the provision of CRM devices and recommendations based on these findings.

The report and press release are available to view and download from:

CRM Devices National Audit Report 2015-16 (pdf)

Press Release (pdf)

The National Audit of Cardiac Rhythm Management publishes new information in the 2014-15 devices annual report

A large number of patients at risk of sudden cardiac death are not being treated appropriately, according to the National Audit of Cardiac Rhythm Management Devices 10th annual report.

Despite recent NICE (National Institute for Health Care & Excellence) guidelines recommending the use of implantable cardioverter defibrillators (ICDs) in a wider range of patients, the figures for 2014/15 show that the UK implant rate is still half the European average, despite having risen since last year.

The report also shows that pacemaker implant rates remain static but also well below the European average. Meanwhile Cardiac resynchronization therapy (CRT) implants, an effective therapy that improves the heart’s ability to pump blood and oxygen to the body, continues to rise; the total rate of CRT implantation in the UK is now above the European average.

Most centres report very high rates of appropriate pacemaker type for sinus node disease, the sinus node is the heart’s natural pacemaker, and the overwhelming majority of pacemakers and complex devices are implanted in centres that do sufficient numbers to meet the recommended standard. However, a small proportion of procedures are reported from centres with extremely low implant rates.

The National Audit of Cardiac Rhythm Management audit details implants of pacemakers, defibrillators, and cardiac resynchronization therapy (CRT) in the UK.

The National Audit of Cardiac Rhythm Management is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) and is led by the National Institute of Cardiovascular Outcomes Research (NICOR) working closely with the British Heart Rhythm Society (BHRS).

Dr Francis Murgatroyd, Chair of the British Heart Rhythm Society Audit Committee and Clinical Lead of the CRM Audit said:

“Pacemakers are implanted in patients to prevent the heart beating too slowly or stopping, which can cause blackouts.  Although the number of pacemakers implanted has increased by 25% over the last 12 years, in line with an ageing population, the UK remains somewhat below the European average for implants, suggesting that many patients that need pacemakers are not receiving them

The 2014-5 audit shows that the overwhelming majority of devices in the UK are implanted in centres that easily meet the BHRS standard.  However, a number of centres are either not reaching this standard or are not reporting all their procedures to the audit.  In future years the audit will identify both individual centres and individual implanters who are undertaking small procedure numbers and may not have sufficient ongoing experience to be safe and sustainable.”

The figures measure cardiac device implants in hospitals in England and Wales for the period April 2014 to March 2015. This is the second of these annual reports to present information by individual hospitals.

View or download the report

Any comments or queries to Anthony Bradley at NICOR:

a.j.bradley@ucl.ac.uk

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.

Ablation Report 2014

The 9th annual report of the National UK Cardiac Rhythm Management (CRM) Ablation Audit Report covers ablation for cardiac arrhythmias during the 2013/14 financial year, along with trends over preceding (calendar) years.

The report highlights a widespread variation in ablation rates per capita both within regions and through the UK. However, larger centres appear to perform more AF ablation procedures in proportion to other types of ablation.  When comparing with immediate Western European neighbours, ablation rates in the UK remain low and are below the average for ‘greater’ Europe.

The full report can be read by following the link given below:

More information about the audit can be found by following the link below:

CRM Audit Annual Report for 2013-14 Now Available

The 9th annual report of the National Audit of Cardiac Rhythm Management (CRM) Devices was published on 19 December 2014.

The report details the number of implants of heart pacemakers and other devices carried out by every hospital in England and Wales between April 2013 and March 2014. It is the first of these annual reports to present information at hospital level.

The report is available to view and download from:

www.ucl.ac.uk/nicor/audits/cardiacrhythm/reports

www.devicesurvey.com

Headlines from the report are:

Total UK implant rates have increased but remain below the European average.

There has been a steady increase in pacemaker implant rates across the UK in recent years, in line with an ageing population./

Cardiac resynchronization therapy (CRT) implant rates have continued to increase and approach or exceed national targets.

NICOR CRM Devices 2012 Annual Report

The 2012 annual report on devices from the Cardiac Rhythm Management National Audit has now been published. It is available to view and download from:

http://www.ucl.ac.uk/nicor/audits/cardiacrhythmmanagement/publicreports

www.devicesurvey.com

This report includes summary information by Local Area Team (LAT) – the data from 2010 and 2011 has been re-analysed by this new output area to allow serial comparison. Full reports by individual LAT will follow as soon as possible.

Headlines from the report are

· a striking rise in CRT device implants

· ICD and simple pacemaker implants show little change.

Any comments or queries to Morag Cunningham at NICOR:

morag.cunningham [at] ucl.ac.uk

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