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Local improvement following national clinical audit workshops Auditing heart attacks Saving lives

Learn about national clinical audits on heart attacks, challenges, data usage, and impact. Explore STEMI, NON-STEMI, and effective treatments for acute coronary syndromes. Discover the importance of timely treatment in reducing mortality rates.

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Local improvement following national clinical audit workshops Auditing heart attacks Saving lives

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  1. Local improvement following national clinical audit workshops Auditing heart attacks Saving lives Dr Andrew Wragg Barts Health

  2. Overview • National Audits related to Acute Coronary syndromes • What do they involve • What are our challenges • How do we use data: how does it change practice • What difference has it made

  3. What is a Heart Attack?

  4. What is a STEMI and a NON STEMI It is all about ST segment elevation

  5. More than just an angioplasty • Prompt recognition of symptoms • Heart monitoring and resuscitation • Prevent further coronary thrombosis • Reduce and reverse ischaemia • Prevent future MI • Education

  6. Overview • National Audits related to Acute Coronary syndromes • What do they involve • What are our challenges • How do we use data: how does it change practice • What difference has it made

  7. NICOR MINAP (2000) • Myocardial Ischaemia National Audit project • All patients presenting with a Acute Coronary Syndromes (ACS) • Includes STEMI, Non STEMI and non cardiac chest pain • All hospitals who receive acute admissions BCIS (1991) • British Cardiac Intervention Society Audit • Cover all angioplasty procedures • All hospitals undertaking angioplasty

  8. MINAP/ BCIS • National clinical audits of heart attack management • Hospitals, ambulance services and commissioners have a record of their management of heart attack patients • Comparative analysis against nationally agreed standards • Allows comparative data between centres and regions • Clinicians and managers can monitor and improve quality and outcomes of their local services

  9. Overview • National Audits related to Acute Coronary syndromes • What do they involve? • What are our challenges? • How do we use data: how does it change practice • What difference has it made

  10. Lots of Data and Manpower • > 100 questions in each dataset • Detailed medical and technical information • Approx 1800 PCI and 1200 MIs at LCH pa • BCIS done by medics • MINAP done by specialist nurses • IT Support needed BUT huge impact Nationally

  11. Prescription of secondary prevention medication • 5 drugs shown to improve outcome after AMI • Aspirin/ Statins/ B Blockers/ ACE I and Clopidogrel

  12. Use of secondary prevention post MI continues to improve BLT: over 97% for all therapies MINAP report 2010

  13. 30 day mortality post STEMI continues to decline MINAP report 2010

  14. Time is muscle!

  15. Relationship between time to treatment and 1-year mortality De Luca, G. et al. Circulation 2004;109:1223-1225 1791 patients with STEMI in USA % Mortality 12 10 8 Double mortality for delay of 3 hours 6 4 2 240 360 60 120 180 300 Ischaemic time (call to balloon)

  16. Key Performance targets STEMI (CQC) • Call-to-balloon (CTB) audit standard 150 mins • Door-to-balloon (DTB) audit standard 90 mins Length of stay Mortality

  17. PCI for Acute SxFour admission scenarios Admitted from the community D1 Admission to Non-PCI centre CTB D2 DTB Direct admission to PCI centre Transfer to PCI centre V device

  18. Performance time targets • Door to balloon: 80% less than 90 mins • Call to balloon: 75% less than 150 mins • Direct transfer rate: >80%

  19. How did BLT do!2009 data • Door to balloon: 85% < 90 mins • Call to balloon: 56% < 150 mins • Direct transfer rate: 50% We had to improve! • Door to balloon: 80% < 90 mins • Call to balloon: 75% <150 mins • Direct transfer rate: >80%

  20. Overview • National Audits related to Acute Coronary syndromes • What do they involve • What are our challenges • How do we use data: how does it change practice • What difference has it made

  21. HAC Daily Audit Weekly Report Straight to Lab Internal DTB<60 Straight to Table

  22. Week commencing: 10th – 16th ~February 2012 (Excluding patients who were shocked/ ventilated or initial diagnosis not STEMI) Source: Heart Attack Centre Audit Team * Excludes patients in Cardiogenic shock, ventilated or already in hospital at time of STEMI CQC targets: 75% patients call – balloon time should be <150 minutes These figures may be subject to change pending feedback from LAS and NELN hospitals abcd

  23. What was the impact?

  24. Length of stay post PCI

  25. Conclusion • MINAP and BCIS are powerful audits • Great drivers of change • Tool for transforming prognosis • C2B target worthy of its CQC point! • Great resource for local research • However, not cheap! Significant resource required to do them well

  26. Local improvement following national clinical audit workshop Dr Andrew Wragg Barts Health Acknowledgements: cardiology team/ LAS/ NELCS network/ HAC audit team/ MINAP and BCIS

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