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PCI in the UK: Fit for service? A view from the Department of Health. Professor Roger Boyle CBE National Director for Heart Disease and Stroke Department of Health. CONFLICTS OF INTEREST I work for the Department of Health!. Acknowledgement

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slide1

PCI in the UK: Fit for service?

A view from the Department of Health

Professor Roger Boyle CBE

National Director for Heart Disease and Stroke

Department of Health

slide2

CONFLICTS

OF INTEREST

I work for the

Department of Health!

slide3

Acknowledgement

I have drawn on Peter Ludman’s work quite extensively

slide5

SAVING LIVES

I

A

T

H

Target achieved

five years

ahead of

schedule

Health Improvement

Analytical Team

Immortality

guaranteed by 2026

Monitoring Unit

Circulatory Disease Mortality TargetDeath rates from All Circulatory Disease in England 1993-2006 and targetPersons under 75

Death rate per 100,000 population

Progress since baseline:

A fall of 40.3%

141.0

Target:

40%

minimum reduction from

1995-97 baseline rate

84.2

84.6

3 year average

baseline

Progress

target

Rates are calculated using the European Standard Population to take account of differences in age structure.

ICD9 data for 1993 to 1998 and 2000 have been adjusted to be comparable with ICD10 data for 1999 and 2001 onwards.

Source: ONS (ICD9 390-459; ICD10 I00-I99)

bcis peer review system
BCIS Peer Review System
  • New PCI centres should be subject to BCIS peer review BEFORE starting
  • Minimum number of cases should be 200 per year with clear plans to increase to 400 per year
  • Minimum of three operators
  • Arrangements for surgical cover
  • Network agreement to the service
slide19

England – Total Waiters – by SHA –

April 2004 – August 2008 - Angiography

Last 3 years 5 months

slide20

England – Total Waiters – by SHA –

April 2004 – August 2008 - PCI

PCI

Last 3 years 5 months

rationale for niap
Rationale for NIAP
  • Need for test of feasibility in NHS
  • Need for cost-effectiveness data relevant to NHS
slide24

PPCI

Lysis

No Reperfusion

niap and national guidance launch event
NIAP and National Guidance launch event
  • Key issues
    • General acceptance of direction of travel
    • Debate regarding the proportion of the population that would still require thrombolysis
    • DH estimate that we can reach 97% of population, others more like 80%
  • Other issues
    • Some pushback regarding our statement advising against hybrid models
peter weissberg medical director bhf
Peter WeissbergMedical Director BHF

“We must not replace a first class thrombolysis

service, which is proven to save lives, with a second

class angioplasty service, which might not.”

slide30

Sunday Mirror

Mail on Sunday

future network plans
Future Network Plans
  • 10 networks have full 24/7 PPCI service
  • 6 networks have a business case for PPCI

Of these:

  • 3 networks plan to have 24/7 PPCI by March 2009
  • 1 network will commence in Jan 2010
  • 12 in the process of developing business case

Some hybrid service due to travel times and 120 minute window

results from alkk
Results from ALKK

P for trend 0.004

Zahn et al Heart 2008; 94: 329-35

18 504 consecutive patients in us
18,504 consecutive patients in US

Adjusted odds ratio of adverse CV events by volume per operator

Moscucci et al, JACC 2005; 46:625-632

paris pci registry
Paris PCI registry

Spaulding et al European Heart J 2006; 27: 1054-1060

slide37

MINAP – STEMI IN HOURS & OUT OF HOURS – 2007

Per Week (average) - By SHA of Admission

Missing

Data

London

Chest

Based on 55% In Hours / 45% Out of Hours

AVE PER

WEEK

consensus event 24 th september
Consensus event 24th September
  • One fifth of England’s cardiologists present
  • General agreement that Networks were the right building blocks for planning purposes for angioplasty services
  • General agreement that BCIS had a major role in setting standards and continuing peer review visits
  • General agreement that we should move to reporting and publishing outcome data
  • Less consensus as to how and where PCI services should be provided
  • Also doubts about minimum numbers for PPCI