1. BCIS Audit ReturnsAdult Interventional Procedures2002 Peter F Ludman BCIS National Audit Officer On behalf of British Cardiovascular Intervention Society Brighton 2003

2. Audit Domains • Structure • Appropriateness • Process • Outcome

3. Audit Domains • Structure • Appropriateness • Process • Outcome

4. UK Intervention Centres

5. 2002 PCI centres 64 Angiography only Centres 65

6. UK Interventional and Diagnostic centres2002 *Missing data assumed to be equal to previously reported activity

7. Interventional Harley Street Diagnostic only Ayr Hospital Derbyshire Royal Infirmary Inverclyde Royal Hospital Lister, Stevenage Mayday University Hospital Nevill Hall Hospital, Abergavenny Northwick Park Hospital Rotherham Hospital Royal Gwent, Newport Salisbury District Hospital St Mary's, Portsmouth Sunderland Royal Hospital Centres not reporting diagnostic numbers

8. Angiograms per PCI

9. Angiography : PCI ratesEurope 2000

10. Annual Procedures per cath lab(NHS centres) *Mobile lab excluded

11. Interventional centres providing NO DATA • None

12. Number of PCIs performed in NHS Centres(total per annum)

13. Total UK PCI Procedures

14. Rate of increase in Procedure numbers per million Change in population estimate

15. PCI Rates per million population (UK) Assumes UK population of: 58.8 m mid 2001, 59.2m mid 2002

16. Total PCIs in the UK Countries(2000 to 2002) Total No.s of PCI

17. PCIs/million UK Countries(2000 to 2002) NSF NB Wales data does not include those treated in England

18. Rates of PCI(Commissioned in England 2002/3) NSF

19. PCI rates versus SMR (Commissioned in England 2002/3) Correlation coefficient - 0.3 (p = NS)

20. PCI vs Isolated CABG Numbers (UK)Data from BCIS and SCTS Registry Ratio PCI:CABG 1.3 1.5 ? 1.7

21. PCI vs CABG breakdown(Commissioned in England 2002/3) Ratio 1.4 : 1

22. PCI and CABG rates per million(Europe 2000) Ratio PCI:CABG 2.3 3.3 5.4 2.4 4.1 3.0 1.7 1.4 2.8 2.0 0.9 4.2 1.3 1.8 1.4 2.0 0.7

23. Ratio PCI: CABG(Europe 2000)

24. No. of Interventional Consultants(NHS centres, UK 2002) Total = 312 Includes local and visitors, cardiologists and radiologists Mean 2000 5.5 2001 6.1 2002 6.5

25. No of PCIs per Consultant (NHS Centres)data from 48 centres Mean PCI/consultant: 2000 125 2001 126 2002 138 Note: data from institutional volume divided by No operators per institution

26. Visiting Interventionists(NHS Centres 2002) 4.7 Interventionists/Centre Mean: 156 PCIs/year 7.6 Local + Visitors/Centre Mean: 127 PCIs/year

27. Surgical cover(Data for 2002) * NHS Centres only

28. Audit Domains • Structure • Appropriateness • Process • Outcome

29. Appropriateness • Indications • Severity of symptoms • Objective assessment of myocardial ischaemia • Angiographic disease severity • etc. • Risk stratification • Clinical presentation • LV function • Renal function • etc.

30. CCAD

31. Audit Domains • Structure • Appropriateness • Process • Outcome

32. No data None Minimal Data None Minimum Data (form B) Minimal or No data from:

33. Stent procedures 1992 - 20022002 data from 63 of 64 centres

34. Stenting in different centres 1998-20022002 data from 63 of 64 centres

35. PCI for Restenosis 1998 - 2002(2002 data from 48 of 64 centres)

36. PCI in patients with past CABG 2002(Data from 45 of 64 centres) Mean 8.4% Note: Includes procedures on native vessels and grafts

37. Use of GP IIb/IIIa blockers2002 data from 62 of 64 centres Note: Possible underestimate of small molecule use

38. Abciximab in different centres 1999 - 20022002 data from 62 of 64 centres

39. Abciximab use by Clinical Presentation(2002 data from 47 of 64 units)

40. Other CoronaryInterventional Techniques (1)2002 data from 62 of 64 centres *% of all UK interventional procedures **Mean number in units using the technique ***Range in units using the technique ¥PercuSurge, Rescue, Angiojet, X-sizer

41. Other CoronaryInterventional Techniques (2)2002 data from 62 of 64 centres Self reported data not specially requested *% of all UK interventional procedures **Mean number in units using the technique ***Range in units using the technique

42. Non coronary cardiac intervention2002 data from 62 of 64 centres * Some centres give combined data for ASD/PFO closure

43. Mitral Balloon Valvuloplasty2002 33 of 64 centres perform MBV

44. Great vessel intervention2002 data from 62 of 64 centres

45. Other Diagnostic Techniques2002 data from 62 of 64 centres *% of all UK interventional procedures **Mean number in units using the technique ***Range in units using the technique

46. Other procedures2002 data from 62 of 64 centres

47. Audit Domains • Structure • Appropriateness • Process • Outcome

48. City Hospital, Birmingham Yorkshire Heart Centre University Hosp. Of Wales Edinburgh Royal Infirmary London Chest Freeman, Newcastle Northern Gen. Hosp. Sheffield St Bartholomew's Plymouth Derriford Ross Hall Hospital London Independent St Anthony's The Priory, Birmingham HCI, Glasgow (Golden Jubilee National Hospital) Harley Street Clinic Yorkshire Clinic, Bradford BUPA Lea (Cambridge) ANY Outcome Data (form C)Inadequate or No Data

49. Cath lab only Blackpool Victoria Yorkshire Heart Centre St Mary's Papworth Hospital Glasgow Western Infirmary Wythenshawe, Manchester City Gen. Hosp. Stoke Hairmyres BMI Alexander, Manchester London Bridge Hospital BUPA Leicester Cromwell The Priory, Birmingham Yorkshire Clinic, Bradford BUPA Lea (Cambridge) Unspecified Belfast City Hull RI & Castle Hill Walsgrave Hospital, Coventry Manchester Royal Infirmary Heart Hospital (Middlesex/UCH Northern Gen. Hosp. Sheffield St George's Eastbourne Wellington Hospital BUPA Leeds Ross Hall Hospital London Independent St Anthony's Harley Street Clinic Bristol BUPA Park, Nottingham HOSPITAL outcome Data (form C)No data from:

50. All PCI Procedures: Mortality Includes all centres reporting cath lab outcome or hospital outcome