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