Development of PCI Strategies: Catchments DemandVolumes West Midlands SHA

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Development of PCI StrategiesCatchments/Demand
/VolumesWest Midlands SHA

• Dr Stephen Green
• DH Vascular Programme
• October 2008

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Background

• This slide pack has been prepared following the
  Angioplasty Consensus meeting held on 24th
  September 2008.
• It is an SHA specific version of the presentation
  made by Stephen Green (Email stephen.x.green_at_dh.gs
  i.gov.uk)
• It contains information about
• Acute MI and CABG based tertiary catchment areas
  populations
• Projected future numbers of revascularisations
  and PCIs
• Modelling future Trust PCI numbers
• The balance of local interventions (angiography
  and PCI) by cardiac network
• MINAP data on STEMI and nSTEMI by hospital
  cardiac network showing expected STEMI numbers
  per year and per week.

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Catchment Populations

• DGH/Secondary - defined by where Acute MIs go
• Tertiary Centres defined by where CABGs go

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Identifying the flow of Acute MIs to define
DGH/ Secondary Trust Catchment Populations
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Identifying the flow of CABGs to define Tertiary
Centre Catchment Populations
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The National Map
Before the development of Wolverhampton
Basildon centres catchments
Acute MI Catchments
Tertiary CABG Catchments
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Before the development of Wolverhampton centre
catchment
West Midlands Acute MI Catchments
West Midlands Tertiary Catchments
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Catchment Populations of Trusts Admitting Acute
MIs 1997 2004 (Controlled to England National
Population)
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Catchment Populations of Trusts Admitting Acute
MIs 1997 2004 West Midlands SHA
Now combined
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Future Numbers of Revascularisations
PCIsProjections
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Cardiac Stocktake South East

• Projections for the years 2008, 2010, 2015 for SE
  the whole of England
• Projected national revascularisation rates of
  1900, 2200 2500 per million in 2015 based on
  weighted populations (age, sex and relative
  mortality)
• PCIs based on projected national ratios of PCIs
  to CABG

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Revascularisation Rates per Million Population
- Actual 2000/01 2006/7 Projected Rates of
1900, 2200 2500 by 2015 - England
Actual
Projection scenarios
Projections Based on Cardiac Stocktake (South
East) methodology projection years 2008, 2010
2015 national destination rates of 1900, 2200
2500 pmp by the year 2015
England
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Revascularisation Change in Ratio of PCIs
CABGs Actual 2001/02-2006/7 SE Stocktake
Projected Ratios for 2008, 2010 2015 West
Midlands
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Modelling Trust PCI Numbers

• Catchment areas based on where Acute MIs go but
  some Trusts may expand catchment for PCIs e.g.
  Royal Bournemouth, Royal Free
• PCI numbers based on ratios referred to above
• PCI numbers shown are the total PCIs expected for
  the Trust Acute MI catchment area (could model
  e.g. max of 85 local)

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Modelling Trust PCI Numbers

• Added into the picture
• 1. BCIS Audit 2006 PCI Sites
• 2. Trusts reporting PCI activity with PCI Waiting
  List returns in January 2008
• 3. Trusts costing PCI in volumes 10 plus for
  2006/7 HRG4 reference costs
• 4. Future intent to do PCI based on DH BLF Cath
  Lab survey
• 5. BCIS Peer Review visits not yet showing up in
  other data sources

FUTURE INENT
BCIS Peer
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Balance of local interventions by Cardiac Network

• Using HRG4 data about 2006/7 Year

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Different Patterns in the development of local
Angiography and PCI across the country
West Country Cardiac Network
Cheshire Mersey Cardiac Network
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There will have been further movement since
2006/7 in some places
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There will have been further movement since
2006/7 in some places
Pre opening of Basildon centre
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MINAP DataSTEMI

• What can MINAP tell us about
• Potential PCI Numbers?
• Average numbers of STEMIs per week
• By SHA
• By Cardiac Network
• By Hospital

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MINAP STEMI nSTEMI 2007 By SHA of Admission
Missing Data London Chest
FULL YEAR
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MINAP STEMI nSTEMI 2007 By Hospital of
Admission
FULL YEAR
West Midlands SHA
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MINAP STEMI IN HOURS OUT OF HOURS 2007 By
SHA of Admission
Missing Data London Chest
Based on 55 In Hours / 45 Out of Hours
FULL YEAR
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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
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MINAP STEMI IN HOURS OUT OF HOURS 2007 By
Cardiac Network of Admission
Missing Data London Chest
Based on 55 In Hours / 45 Out of Hours
FULL YEAR
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MINAP STEMI IN HOURS OUT OF HOURS 2007 Per
Week (average) By Cardiac Network of Admission
Missing Data London Chest
Based on 55 In Hours / 45 Out of Hours
AVE PER WEEK
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ENGLAND - MINAP STEMI 2007 By Hospital of
Admission
FULL YEAR
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ENGLAND - MINAP STEMI 2007 Per week
(average) - By Hospital of Admission
AVE PER WEEK
Based on 55 In Hours / 45 Out of Hours
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MINAP STEMI 2007 Full Year By Hospital of
Admission
FULL YEAR
West Midlands SHA
Based on 55 In Hours / 45 Out of Hours
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MINAP STEMI 2007 Per Week (average) By
Hospital of Admission
Based on 55 In Hours / 45 Out of Hours
AVE PER WEEK
West Midlands SHA
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CONCLUSIONS

• We know what existing catchment areas look like
  SHA groups will have copies of those this
  afternoon
• Future number of PCIs have been projected across
  the country under different assumptions we know
  which Trusts look viable at the 400 PCIs p.a
  level SHA groups will have copies of those this
  afternoon
• MINAP has the number of STEMIs that have been
  reported
• We can therefore make a broad assessment of the
  total number of PPCIs in and out of hours by SHA,
  network hospital
• Combining this with recommended CTB times will
  provide the site options for effective economic
  implementation of PPCI