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ACI 2010 : Awaiting the congress report........

More than 800 delegates. Three days including live transmissions on Wednesday.

London January 2010

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The audit of PCI in the United Kingdon for the calender year 2008 was analysed and presented by Peter Ludman at the BCIS autumn meeting in Bournemouth
The number of PCI centres has risen to 105, and 80,331 procedures were performed. This equates to 1,308 PCI pmp, but there remain significant differences in PCI rates between the different countries of the UK. The rate of increase was the smallest seen in recent years. The use of primary PCI to treat patients with STEMI continues to rise sharply, with 50% of all UK centres now offering this service 24/7. The demographics of the treated population shows small increases in age and co-morbidity, and a consistent and large difference in the prevelance of diabetes was noted between South Asian and European patients. A tentative analysis of appropriateness showed that only 3.3% of PCI appeared to be performed inappropriately, with missing data on a further 8.8%.
The circadian distribution of PPCI activity was demonstrated, and door to balloon times and call to balloon times were reasonable at 53.8 min and 116.6 min respectively. Radial access was associated with fewer access site complications, and also stroke. There was no increase in door to balloon times for patients being treated by PPCI. Risk adjusted outcomes were assessed by cumulative funnel plots and no PCI unit showed rates of complications significantly higher than predicted.

Download the presentation

The 2009 BCIS Autumn meeting was held on Friday 16th October in the Royal Bath Hotel, Bournemouth.

As during previous years, the meeting focussed on clinical aspects of interventional cardiology, and an interesting programme of presentations, case reviews and debates, with ample time for discussion, was compiled by our Bournemouth colleagues.

This year we saw a record attendance with close to 350 delegates.

Well done and congratulations to the Bournemouth team for putting together a great Autumn meeting !

Access to Care- Updated Report published

The original National Service Framework (NSF) for cardiology was published in 2000 and has been interpreted by some as representing a 10 year plan. Although this was not intended, the BCS and the BHF have been involved in developing the Cardio and Vascular Coalition (CVC), a coalition of 40 charities. BCIS has joined this coalition.

The CVC has produced a document “Destination 2020” which can be downloaded from the BHF website. This highlights the enormous strides that have been made over the last 8-9 years and outlines work needed to build on these achievements. The BHF will continue to ensure that the cardiology specialties are kept to the forefront in national debates about resource allocation, and this will be particularly relevant given the expected squeeze on NHS funding over the next few years.

The government is not proposing a new “NSF” but has introduced a series of strategies that are important for future progress. There is no doubt that the professional groups must engage with NICE as this is the mechanism by which treatment guidelines are assessed. Its decisions influence resource allocation. The Improvement Programme working together with the Clinical Networks helps to promote best practice and influences commissioning decisions at a local level. We must all engage with these processes to help get the best deal for patients.

Previously, two BCS Working Groups had produced a report on regional variations in numbers of specific procedures, as well as producing a document related to the need for an expanded workforce to deliver care

The BCS together with the BHF and the CVC have commissioned an updated report on clinical activity and looks at estimated growth in activity over the next few years. You can download both the executive summary and the full report This report highlights procedures, but it is important to realise that it is not designed as a comprehensive evaluation of all that cardiologists get up to. There is a continuing north-south divide. Reasons for variation are complex and are not always related to lack of cardiologists.
Nevertheless, the reports make interesting reading and you may well find them useful in your local discussions. An additional report that performs an analysis at local authority rather than regional level is expected soon.

Mark de Belder
BCIS President
15th June 2009

Dear colleagues

The database to collect information about the transcutaneous implantation of aortic valves in the UK is now ready to be used, and will allow data to be directly uploaded to CCAD. The process will occur in 2 phases:

Phase 1. As of now, you can submit data via the newly designed web based database entry system.

This allows any one with a web browser and internet connection to upload data. CCAD have an on-line registration facility. Registration must be performed by the SCTS or BCIS main audit contact so please liaise with your main contact if you want to register. Please go to http://www.ncasp.org.uk and select the Transcatheter Aortic Valve Implantation (TAVI) link. You will then be asked to identify the main contact and specify the number of users and type of access required. You are then asked to submit the form. Login in details with CCAD's terms and conditions will be sent via email to each user. For security reasons users are then asked to contact the helpdesk for the password.
If you have any problems with registering please contact the CCAD helpdesk team on 0845 300 6016 option2 or email: helpdesk@ccad.org.uk

Phase 2. Hospitals using commercial software or locally developed software will be able to upload data from their own databases but this facility will not be available until phase 2. This phase will also bring the functionality or reader access (to view reports/analyses)

Please dont hesitiate to contact me or CCAD if you have any questions about this process

Peter Ludman

Audit lead for BCIS

Related Article on this Webpage: TAVI in the UK

The Advanced Cardiovascular Intervention 2009 conference took place at the London Hilton Metropole from Wednesday 28th to Friday 30th January. Previously “Advanced Angioplasty”, the conference has been renamed to embrace the expanding repertoire of non-coronary cardiovascular procedures performed by Cardiology teams both nationally and internationally.

Read the full Meeting Report by Rob Hatrick and Mark Signy.

The main presentations are available: ACI 2009

Manchester/Oxford October 20th 2008

Primary angioplasty (PPCI) is the preferred treatment strategy for patients presenting with acute ST elevation myocardial infarction and should become the default revascularisation strategy in the UK within the next three years. This robust conclusion is at the heart of the National Infarct Audit Project (NIAP) Final Report prepared by Dr Huon Gray and Professor Roger Boyle on behalf of The Department of Health and presented to a wide multidisciplinary meeting attracting almost 600 delegates in Manchester and Oxford on October 20th 2008.

The NIAP project enrolled over 2000 patients presenting with STEMI to seven pilot sites around the UK over a one year period from April 2005. Centres were selected on the basis of their diversity of geographical catchment and models of service delivery and outcome measures determined the applicability of PPCI in the UK NHS setting, optimal treatment pathways, cost effectiveness, and service impact on patients, carers and healthcare professionals.

The principal conclusions, presented by Huon Gray and endorsed by supplementary contributions from Roger Boyle, Bruce Keogh and Mark de Belder are as follows:
• National roll-out of PPCI is feasible within the next three years but may be logistically challenging in some parts of the country.
• A call-to-balloon time of 120 minutes should be achievable and services are likely to be audited against this standard. A PPCI service needs to achieve this target reliably regardless of the time of day or day of the week.
• Such a target would make PPCI potentially applicable to 97% of cases of STEMI in England.
• Hybrid services offering daytime PPCI and out of hours thrombolysis are not satisfactory.
• A PPCI service should be operational 24/7 and carried out in centres with sufficient caseload to maintain and develop skills.
• If an acceptable PPCI service cannot be established, pre-hospital rather than in-hospital thrombolysis is preferred. Early coronary angiography +/- PCI is recommended in all patients who receive thrombolytic therapy.

These recommendations are consistent with forthcoming ESC guidelines on the management of STEMI, presented to the meeting from Belgium via video satellite link by William Wijns, President of EAPCI. Although the roll out of PPCI in the UK will present a variety of logistic, economic and local political challenges (all of which were debated freely during the prolonged interactive sessions within the meeting programme), a clear consensus has emerged that PPCI is the way forward. Dr Jim McLenachan from Leeds has been appointed to the NHS Improvement Programme team and will be travelling around the country over the next year or two to facilitate regional implementation of this change in policy.

This is a very significant landmark. It is a testament to the many people who have believed in this change that we have gone from delivering virtually no primary angioplasty to having a national consensus on a change in strategy. BCIS Council support this consensus and the conclusions of the NIAP project.

Dr Mark de Belder
BCIS President

Dr Bernard Prendergast
BCIS Honorary Secretary

A PDF version of the NIAP final report
Hard copies are obtainable from Sue Dodd at The Department of Health.

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