National Cardiac Audit Programme

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The National Cardiac Audit Programme (NCAP) Annual Report 2024 focuses on the after-effects of the COVID-19 pandemic, potentially important post-pandemic shifts in the demand for cardiovascular services, how these are provided, and the variability experienced in different locations, meaning that not everyone has access to the same high-quality cardiac care.

The impacts on healthcare continue to be seen with challenges in restoring service capacity and delays to treatment. Other challenges have added to the effects of the pandemic, including difficulties in staff retention and recruitment, the onset of industrial action and the cost-of-living crisis. These all compound the burden on an already pressured NHS facing increasing demands from an expanding and ageing population.

Levels of activity for most cardiovascular sub-specialties have continued to improve and are higher than the levels seen in 2020/21 during the COVID-19 pandemic. Some areas remain below pre-COVID levels, most notably adult and paediatric cardiac surgery.

In what remains a turbulent time for the NHS, areas of excellent practice are seen, with improved quality of care across many areas of clinical practice. This is not universal however, and the report sheds light on the variability experienced by patients in different parts of the country and individual hospitals. This remains the case especially for patients suffering a heart attack and those in need of either urgent or elective cardiac bypass surgery. Additional variances are also experienced depending on a patient’s age and sex.

The Annual Report is accompanied by supporting interactive reports from eight sub-specialties covered by the audit programme and a dedicated Annual Report for Patients, Carers and the Public, which was supported by the NICOR Community Representative Group Chair, Sarah Murray, and patient representatives Richard Corder and Richard Mindham.

NCAP Aggregate Report 2024

The report covers the 12 months from 1 April 2022 to 31 March 2023 and explores what could be potentially important post-pandemic shifts in the demand for cardiovascular services, how these are provided, and the variability experienced in different locations. NCAP now includes 11 cardiovascular audits and registries, eight of which provide results to this 2024 report.

Post-pandemic shift: admissions and procedures

The icon colours indicate the different sub-specialty sources of the data.

  • The number of confirmed heart attacks has fallen 4% since 2017/18.

  • 43% of patients aged 75 and over who undergo a TAVI procedure are female (a lower proportion than might be expected).

  • In 2022/23, the number of heart attacks per 100,000 people was 4 times higher in Merseyside and Wales compared with areas with lower rates.

  • Surgical procedures for congenital heart disease have fallen 23% over 10 years, with interventional procedures rising by 9%.

  • 1 in 10 people with higher risk heart attacks are ‘self-presenting’ to hospital rather than travelling by ambulance, potentially delaying life-saving medical treatment.

  • 74% of patients undergoing a complex percutaneous coronary intervention (PCI) did not have this checked with intracoronary imaging.

  • The median Call-To-Balloon time for higher risk heart attack patients undergoing primary angioplasty has worsened by 28% since 2013/14.

  • 63% of acute coronary syndrome patients (with sudden, reduced blood flow to the heart) were not prescribed either prasugrel or ticagrelor, contrary to medication guidelines.

  • The average waiting time for elective coronary artery bypass graft (CABG) surgery in England, Wales and Northern Ireland is 119 days, the target is under 84 days.

  • 82% of patients with heart failure were seen by a specialist heart failure team, but only 15% of patients cared for on a cardiology ward were referred for cardiac rehabilitation.

  • There has been a 32% drop in the average number of CABG procedures performed annually by each cardiac surgeon since 2013/14.

  • There has been a 17% increase in the use of implantable loop recorders for diagnostic and monitoring purposes since 2017/18.

  • Alternatives to surgery are growing for valve disease cases. There has been a 36% growth in transcatheter aortic valve implantation (TAVI) procedures since 2019/20.

  • 15% increase in the use of more ‘complex’ cardiac resynchronisation therapy pacemakers (CRT-P) to improve heart function since 2017/18.

The number of confirmed heart attacks has fallen 4% since 2017/18.
43% of patients aged 75 and over who undergo a TAVI procedure are female (a lower proportion than might be expected).
In 2022/23, the number of heart attacks per 100,000 people was 4 times higher in Merseyside and Wales compared with areas with lower rates.
Surgical procedures for congenital heart disease have fallen 23% over 10 years, with interventional procedures rising by 9%.
1 in 10 people with higher risk heart attacks are ‘self-presenting’ to hospital rather than travelling by ambulance, potentially delaying life-saving medical treatment.
74% of patients undergoing a complex percutaneous coronary intervention (PCI) did not have this checked with intracoronary imaging.
The median Call-To-Balloon time for higher risk heart attack patients undergoing primary angioplasty has worsened by 28% since 2013/14.
63% of acute coronary syndrome patients (with sudden, reduced blood flow to the heart) were not prescribed either prasugrel or ticagrelor, contrary to medication guidelines.
The average waiting time for elective coronary artery bypass graft (CABG) surgery in England, Wales and Northern Ireland is 119 days, the target is under 84 days.
82% of patients with heart failure were seen by a specialist heart failure team, but only 15% of patients cared for on a cardiology ward were referred for cardiac rehabilitation.
There has been a 32% drop in the average number of CABG procedures performed annually by each cardiac surgeon since 2013/14.
There has been a 17% increase in the use of implantable loop recorders for diagnostic and monitoring purposes since 2017/18.
Alternatives to surgery are growing for valve disease cases. There has been a 36% growth in transcatheter aortic valve implantation (TAVI) procedures since 2019/20.
15% increase in the use of more ‘complex’ cardiac resynchronisation therapy pacemakers (CRT-P) to improve heart function since 2017/18.

NCAP

NATIONAL CARDIAC AUDIT PROGRAMME

The National Cardiac Audit Programme (NCAP) report covers quality of care and outcome measures across ten cardiovascular domains.

Each of these sub-specialty audits is concerned with a particular cardiovascular disease (CVD) of treatment:

NCAP

NATIONAL CARDIAC AUDIT PROGRAMME

The National Cardiac Audit Programme (NCAP) report covers quality of care and outcome measures across ten cardiovascular domains.

Each of these sub-specialty audits is concerned with a particular cardiovascular disease (CVD) of treatment: