Increased usage of safer procedures for cardiac patients, audit finds

Published: 01 Apr 2016

A 48% increase in the use of procedure associated with fewer complications is good news for cardiac patients

The latest audit from the National Audit of Percutaneous Coronary Intervention (PCI) shows an increase
from 26.9% to 75.3% in the use of a safer method of PCI (angioplasty) between 2007 and 2014. The PCI procedure, which involves inserting a tube or catheter into the patient’s arterial system to reach the blocked artery in order to improve blood flow, is associated with fewer complications if carried out through the radial artery in the wrist rather than the femoral artery at the top of the leg. The significant increase has been seen in the use of the safer radial access procedure.

View the full report here

View the full key facts summary here

Peter Ludman, Consultant Cardiologist and Clinical Audit Lead said:
“The impressive increase in PCI procedures with radial artery access for the treatment of STEMI shows that UK interventional cardiologists are keeping up to date with developments in their field, and changing practice in response to evidence showing lower complication rates with this method.”

NICE quality standard [QS68] requires that patients presenting with STEMI receive emergency treatment within 90 minutes from arrival at a specialist heart centre. 90.3% of patients were treated within that time frame in 2014, and this is similar to the standards achieved in the last 3 years. Reasons for missing the 90 minute treatment target can be the result of admission to a non-specialist heart centre, and transfer between hospitals.

Ensuring patients are treated by healthcare staff with sufficient expertise is fundamental to providing excellent care for cardiac patients. The 2005 guidance from the British Cardiovascular Intervention Society (BCIS) and the British Cardiac Society (BCS) therefore recommends institutions carry out 400 of these procedures per annun (ppa). However, in the current audit report, 33% of hospitals – both NHS and private – did not meet this standard.

The audit also reports on patients with unstable angina and non-ST Elevation Myocardial Infarction or STEMI. These patients are at risk of future cardiac events and require urgent but not immediate treatment. Although NICE quality standard [QS68] sets a target for treatment to be delivered to STEMI patients within 72 hours, over half of all patients are waiting longer than recommended. This is an avoidable cause of prolonged length of in-hospital stay and increased treatment cost. As with patients who have STEMI, treatment delays are worse for patients who require transfer to another hospital for PCI treatment.

Peter Ludman, Consultant Cardiologist and Clinical Audit Lead said:
“As the UK switched from thrombolysis to primary PCI to treat STEMI, the focus was on setting up emergency care pathways for these patients that is available 24/7. There has therefore been less focus on patients presenting with UA/NSTEMI. This audit has shown significant delays for these patients, and we must encourage trusts to set up pathways of care to try to speed up investigation of these patients.”

Other messages in the report include:

  • Primary PCI is now the default treatment for patients with STEMI representing approximately a
    third of all PCI activity in the UK
  • Activity levels are now comparable to those in European countries – historically UK levels have
    been lower
  • Regionally, activity rates range between 300 to 500 procedures per million population, Over the
    past three years, patient case mix has stabilised as a result of near national implementation of
    primary PCI – the effect of this has been to stabilise overall in-hospital mortality

Peter Ludman, Consultant Cardiologist and Clinical Audit Lead said:
“The huge effort that goes into collecting these data is a great tribute to all who provide PCI services for patients in the UK. Analyses of these audit data allow us to understand treatment patterns, the process of care and outcomes after PCI. Without this information it would not be possible to either be reassured of satisfactory performance or to be able to highlight areas for potential improvement. We hope patients are reassured that the profession is carefully measuring the quality of care being provided by operators and hospitals. The PCI audit will continue to develop ways of disseminating this information so patients, clinicians, commissioners and other stakeholders can use these data to drive quality improvement nationally and locally.”