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Category Archive: Congenital Heart

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.

Congenital cardiac surgery survival rate continues to improve for children in the UK and Republic of Ireland

Data published today by the National Congenital Heart Disease Audit (NCHDA) shows that survival 30 days after paediatric cardiac surgery for children with congenital heart disease has continued to improve for children in recent years and is currently close to 98%. After consideration of case complexity, survival 30 days after heart surgery for children was either at the expected level or better than predicted in each of the paediatric centres providing care.

Dr. Rodney Franklin, NICOR’s Clinical Lead for the NCHDA said:

“Overall survival after congenital heart procedures in UK and Republic of Ireland remains good and as high as reported anywhere in the world.”

The report also highlights that antenatal ultrasound scan detection rates of congenital heart conditions have improved year on year between 2003 and 2016 from 36.1% to 50.4%, however there is continued room for improvement by targeting sonographer training to regions performing less well.

Dr. Rodney Franklin said: “Antenatal detection is very important because advance warning that a child has a congenital heart problem leads to better planned care after birth, often with improved survival and fewer complications following treatment. The audit is working closely with Public Health England to improve detection in this area.”

The NCHDA collected data following 33,754 congenital heart surgical operations and transcatheter interventional procedures performed in 34 hospitals, including all 14 specialist paediatric units, between 2013 and 2016 in the UK and the Republic of Ireland (RoI). Other key findings from the report include:

During 2015-16, the most recent year, 10,887 therapeutic procedures were carried out, of which 7,695 were on children and 3,192 were on adults; the number of therapeutic cardiac procedures undertaken annually has risen by over 40% between 2003 and 2016, and furthermore additional novel interventions have been introduced, the outcomes of which are reported here for the first time.

Risk adjusted full programme 30-day postsurgical survival at all 14 centres undertaking cardiovascular procedures in children and young people below 16 years of age was within acceptable predicted control limits, with a trend of continuing year on year improvement.

Survival at 30 days after all 72 major surgical and cardiovascular interventions undertaken to treat congenital heart disease at any age was good in all centres, with a single procedural exception at two centres.

The NCHDA, now in its 17th year, is managed by the National Institute for Cardiovascular Outcomes Research (NICOR) and is the largest and most comprehensive national audit of its kind in the world. The audit collects data from all centres undertaking congenital cardiac surgery and interventional procedures in the UK (since 2000) and RoI (since 2012).

NCHDA is commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) and clinically led by the British Congenital Cardiac Association and The Society for Cardiothoracic Surgery in Great Britain and Ireland.

The full analyses can be accessed via the National Congenital Heart Disease Audit portal

Independent Review of Children’s Cardiac Services: NCHDA Recommendations

Bristol Review publishes final report
The Independent Review of Children’s Cardiac Services in Bristol published its final report on 1/7/2016. The full report is available to download via the website.

Commissioned by NHS England Medical Director Sir Bruce Keogh in 2014, and chaired by Eleanor Grey QC, the Bristol Review is an independent review of the safety and quality of children’s cardiac services in Bristol. The report contains recommendations relating to the NCHDA in relation to the outlier policy including:

  • the development of guidance for centres on how to respond to notification of potential outlier status and
  • specific attention to the need for publication of the responses to outlier alerts, and of any actions taken as a result

We welcome the recommendations and recognize the importance of clear guidance and communication.

A full description of the outlier process including timelines and guidance for hospital staff will be available shortly as part of an updated guidance on Data Quality. The guidance will also include a clear process for how the hospital response is reviewed and quality of care assured. All responses will be published on the NICOR website.

NCHDA Aggregate Report 2012/15 v 1.2

Following communication with contributing Trusts, we were notified of an issue with the National Congenital Heart Disease Report 12-15 published on 4th April,  including minor inconsistencies with the tables and funnels for specific procedures published on the NCHDA portal.

The errors have now been rectified and the amended report is now available. We apologize for any inconvenience caused.

NCHDA Aggregate Report V1.2 published 27/4/2016

Important NCHDA 2012/15 Report Update

Following communication with contributing Trusts, we have been notified of an issue with the National Congenital Heart Disease Report 12-15 published on 4th April,  including minor inconsistencies with the tables and funnels for specific procedures published on the NCHDA portal.

We are currently resolving the issue and will re-issue the report as soon as possible.  We apologize for any inconvenience.

National Congenital Heart Disease Audit 2014/15

The National Congenital Heart Disease Audit (NCHDA) publishes the 2012/15 annual analysis. The findings are based on data submitted by 34 hospitals including all 14 specialist paediatric centres.

This covers all NHS and private paediatric and congenital heart disease procedures undertaken at centres in the UK and Republic of Ireland. Analyses are based on 30,929 paediatric and congenital heart surgery and interventions undertaken between April 1st 2012 and March 31st 2015.

Key findings from the report include:

  • during 2014-15, the most recent year, 10,096 procedures were carried out, of which 7,279 were on children and 2,817 were on adults;
  • the number of procedures undertaken and activity levels have increased by almost 40% since 2000;
  • survival at 30 days after all 73 major surgical and cardiovascular interventions undertaken to treat congenital heart disease at any age was good in all centres. All hospitals had survival rates above the alarm limit for all procedures. Only two centres had 30 day survival rates which breached the alert limit for one of the 73 specific procedures during this period:

o Liverpool Heart and Chest Hospital (for surgical repair of atrial septal defect in adults, and

o Evelina London Children’s Hospital (for the Norwood procedure in children);

o both hospitals have been notified, the responses from the hospitals reviewed, and the quality of local services assured.

The full report is available on the NCHDA webpage: http://www.ucl.ac.uk/nicor/audits/congenital/documents/datasets/NCHDA2012-15 Report

Results of all procedures for children and adults are available on the NCHDA public portal: https://nicor4.nicor.org.uk/CHD/an_paeds.nsf/WBenchmarksYears?openview&RestrictToCategory=2013&start=1&count=500

UPDATE: Following communication with contributing Trusts, we have been notified of an issue with  the National Congenital Heart Disease Report 12-15 published on 4th April including minor inconsistencies with the tables and funnels for specific procedures. We are currently resolving the issue and will re-issue the report as soon as possible.  We apologise for any inconvenience.

30 Day Survival Rates Following Congenital Heart Disease Surgery Published Today

The National Congenital Heart Disease Audit (NCHDA) has today published the 2011/14 annual analysis. The findings are based on data submitted by combined 14 paediatric and 20 centres who only undertake procedures in adults with congenital heart disease. This covers all NHS and private paediatric and congenital heart disease procedures undertaken at centres in the UK and Republic of Ireland. Analyses are based on 31,511 paediatric and congenital heart surgery and interventions undertaken between April 1st 2011 and March 31st 2014.

  • Survival at 30-days after each of the 56 surgical and transcatheter cardiovascular interventions most frequently undertaken to treat congenital heart disease in children, young people and adults continues to be within the appropriate limits and not below the red alert limit.
  • For the 56 specific procedures used as a basis of inter‐unit comparison, there was one warning level outliers for paediatric cardiac surgery at a single centre and none for paediatric intervention, adult congenital heart disease (ACHD) surgery and ACHD intervention. The hospital concerned has been contacted by NICOR and the relevant professional societies, and the centre’s response is available on the NCHDA portal.
  • Analysis of the 30 day post procedural outcomes for all hospitals shows an upward trend in survival in the most recent 18 months. The overall 30 day survival for all congenital heart disease procedures is extremely high and indeed one of the highest reported anywhere in the world.
  • Antenatal diagnosis of congenital heart disease has gradually improved over the past 8 years. In 2013/14, approaching 45% of infants who required a procedure to treat a congenital heart malformation in the first year of life were diagnosed through antenatal screening, compared to less than a quarter of cases in 2003/4.

The full report is available here:

http://www.ucl.ac.uk/nicor/audits/congenital/documents/datasets/NCHDA2011-14Report

and results of all procedures for children and adults are available on the NCHDA public portal: https://nicor4.nicor.org.uk/CHD/an_paeds.nsf/vwContent/Minutes%20and%20Newsletters?Opendocument

30 Day Survival Rates Following Congenital Heart Disease Surgery and Interventional Procedures

The National Congenital Heart Disease Audit (NCHDA) has today published the 2010/13 annual analysis. The analysis covers 22,979 congenital heart operations and transcatheter interventional procedures undertaken across 34 UK centres, including all 14 specialist paediatric units, between 2010 and 2013. Key findings include:

  • Survival at 30-days after each of the 56 surgical and transcatheter cardiovascular interventions most frequently undertaken to treat congenital heart disease in children, young people and adults continues to be within the appropriate limits and not below the red alert limit.
  • For the 56 specific procedures used as a basis of inter‐unit comparison, there was one warning level outliers for paediatric cardiac surgery at a single centre and none for paediatric intervention, adult congenital heart disease (ACHD) surgery and ACHD intervention. The hospital concerned has been contacted by NICOR and the relevant professional societies, and the centre’s response is available on the NCHDA portal.
  • Analysis of the 30 day post procedural outcomes for all hospitals shows an upward trend in survival in the most recent 18 months. The overall 30 day survival for all congenital heart disease procedures is extremely high and indeed one of the highest reported anywhere in the world.
  • Antenatal diagnosis of congenital heart disease has gradually improved over the past 8 years. In 2013/14, approaching 45% of infants who required a procedure to treat a congenital heart malformation in the first year of life were diagnosed through antenatal screening, compared to less than a quarter of cases in 2003/4.

https://nicor5.nicor.org.uk/CHD/an_paeds.nsf/vwContent/home?Opendocument

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