PRIMARY PCI - MAKING IT HAPPENPRIMARY PCI - MAKING IT HAPPEN

UK Proposals (BCS/DoH)UK Proposals (BCS/DoH)

Advanced Angioplasty 2005Advanced Angioplasty 2005

Huon GrayHuon GrayConsultant Cardiologist, SouthamptonConsultant Cardiologist, Southampton

President, British Cardiac SocietyPresident, British Cardiac Society

BackgroundBackground

• June 2003June 2003– Heart Team asked to report to the Prime Minister’s Delivery Unit (PMDU) on Heart Team asked to report to the Prime Minister’s Delivery Unit (PMDU) on

‘The impact of early thrombolysis’‘The impact of early thrombolysis’

• July 2003July 2003– Meeting of DoH and PMDU at the Treasury to review Meeting of DoH and PMDU at the Treasury to review

‘The early treatment of myocardial infarction’‘The early treatment of myocardial infarction’

• PresentPresent– Roger Boyle Roger Boyle National Clinical DirectorNational Clinical Director– Heather Gwynn Heather Gwynn CHD Programme ManagerCHD Programme Manager– Maree Barnett Maree Barnett DoH Nurse AdviserDoH Nurse Adviser– Daniel Scheffer Daniel Scheffer DoH Head of Ambulance PolicyDoH Head of Ambulance Policy– Robert Anderson Robert Anderson DoH Economic AdviserDoH Economic Adviser– Tom QuinnTom Quinn NHS Modernisation AgencyNHS Modernisation Agency– Janet Davies Janet Davies CE Mersey Ambulance ServicesCE Mersey Ambulance Services– Katherine Henderson Katherine Henderson A&E ConsultantA&E Consultant– Nick Curzen Nick Curzen Cardiologist, MRICardiologist, MRI– Gordon Murray Gordon Murray Cardiologist, Birmingham & Clinical Lead Cardiologist, Birmingham & Clinical Lead

CHDCollaborativeCHDCollaborative

• Site visits proposedSite visits proposed

BackgroundBackground

• August 2003August 2003– Visits to 3 Acute Trusts and 2 Ambulance TrustsVisits to 3 Acute Trusts and 2 Ambulance Trusts

• Kings College LondonKings College London• St Mary’s LondonSt Mary’s London• South Manchester University HospitalSouth Manchester University Hospital• London Ambulance ServiceLondon Ambulance Service• Greater Manchester Ambulance ServiceGreater Manchester Ambulance Service

PMDU concluded:PMDU concluded:

– “ “ DoH should develop a clear policy for expanding primary angioplasty”DoH should develop a clear policy for expanding primary angioplasty”

– Up to £1m of funding allocated for data collection (not service delivery) in Up to £1m of funding allocated for data collection (not service delivery) in EnglandEngland

• September 2003September 2003– Heart Team approach BCS & BCIS for collaborationHeart Team approach BCS & BCIS for collaboration

• October 2003October 2003– Working Group approved by BCS CouncilWorking Group approved by BCS Council

Working GroupWorking Group

• Huon Gray (co-chair)Huon Gray (co-chair)

• Mark de BelderMark de Belder

• Martin ThomasMartin Thomas

• Keith DawkinsKeith Dawkins

• Martin RothmanMartin Rothman

• Tony GershlickTony Gershlick

• David SmithDavid Smith

• Kevin BeattKevin Beatt

• Rodney FoaleRodney Foale

• Roger Boyle (co-chair) Roger Boyle (co-chair) • Sue DoddSue Dodd Heart TeamHeart Team

• Steve CampbellSteve Campbell CHD CollaborativeCHD Collaborative

• John BirkheadJohn Birkhead MINAPMINAP

• Mark WhitbreadMark Whitbread Ambulance Ambulance ServiceService

• Janet DaviesJanet Davies Ambulance Ambulance ServiceService

• Nick Boon /Nick Boon /Ross LorrimerRoss Lorrimer ScotlandScotland

• Mark SculpherMark Sculpher Health EconomistHealth Economist

Working GroupWorking Group

• 4 meetings in 20044 meetings in 2004– January:January: Define scope of pilot project and discuss overall conceptsDefine scope of pilot project and discuss overall concepts– June:June: More detailed discussion of governance framework, More detailed discussion of governance framework,

pre-hospital & in-hospital issues, data collectionpre-hospital & in-hospital issues, data collectionDataset sub-group established (Mark de Belder)Dataset sub-group established (Mark de Belder)

– Sept:Sept: Discussion of possible sites, protocols, draft dataset, Discussion of possible sites, protocols, draft dataset, method of data collection/analysismethod of data collection/analysis

Sept-Dec Sept-Dec Meetings with NHS Service Delivery & Organisation Meetings with NHS Service Delivery & Organisation (SDO) (SDO)

R&D programmeR&D programme

– Dec:Dec: Dataset (v 1.0) & Scoping Document agreed Dataset (v 1.0) & Scoping Document agreed CCAD presentationCCAD presentation

Pilot to be ‘National Infarct Angioplasty Project (NIAP)’Pilot to be ‘National Infarct Angioplasty Project (NIAP)’

Selected centres invited to submit expressions of interestSelected centres invited to submit expressions of interest

Coverage at BCS Annual Conference and on BCS web siteCoverage at BCS Annual Conference and on BCS web site

Scope of NIAPScope of NIAP

• Not to research efficacy of PCI vs. LysisNot to research efficacy of PCI vs. Lysis• Address feasibility of rolling out a national ‘PCI for AMI’ Address feasibility of rolling out a national ‘PCI for AMI’

programmeprogramme• Ensure assessment of different (English) modelsEnsure assessment of different (English) models

– GeographyGeography– Single centreSingle centre– NetworksNetworks– Inter-hospital transfersInter-hospital transfers– Non-A&E unitsNon-A&E units

• Make cost analysis and comparison with lysis (MINAP)Make cost analysis and comparison with lysis (MINAP)• Assessment of patient experienceAssessment of patient experience• 24 x 7 service delivery24 x 7 service delivery• Data collection on Data collection on allall AMI’s in catchment population over pilot AMI’s in catchment population over pilot

period to be includedperiod to be included• Follow-up for at least 1 yearFollow-up for at least 1 year

Scoping DocumentScoping Document

• General guidance but protocols locally determinedGeneral guidance but protocols locally determined– Pre-hospital (ambulance service)Pre-hospital (ambulance service)

– Inter-hospital transferInter-hospital transfer

– In-hospital (receiving arrangements, cath lab, discharge)In-hospital (receiving arrangements, cath lab, discharge)

– BCIS/BCS recommendations on PCI (BCIS/BCS recommendations on PCI (Heart 2005, in pressHeart 2005, in press))

• Guide times (subject to clinical discretion)Guide times (subject to clinical discretion)– ‘‘Diagnosis’ to ‘arrival PCI centre’ < 60 minutesDiagnosis’ to ‘arrival PCI centre’ < 60 minutes

– ‘‘Patient call for help’ to ‘balloon’ time < 3 hoursPatient call for help’ to ‘balloon’ time < 3 hours

– Not enrolled if ‘onset of pain’ to diagnosis > 9 hoursNot enrolled if ‘onset of pain’ to diagnosis > 9 hours

– Discharge < 72 hours if uncomplicatedDischarge < 72 hours if uncomplicated

• Patient experience (2 centres)Patient experience (2 centres)

• Data collectionData collection

Courtesy of Dr David Cunningham (CCAD)Courtesy of Dr David Cunningham (CCAD)

• Government fundedGovernment funded• Patient confidentiality / ethical considerationsPatient confidentiality / ethical considerations• Potential cross-population / validation of datasets (MINAP, BCIS)Potential cross-population / validation of datasets (MINAP, BCIS)• ONS mortality trackingONS mortality tracking

Currently single-tender exercise (CCAD)Currently single-tender exercise (CCAD)

Dataset covers key elements (particularly cost drivers) from recruitment to follow-upDataset covers key elements (particularly cost drivers) from recruitment to follow-upLocal data collection and download or online data inputLocal data collection and download or online data input

Courtesy of Dr David Cunningham (CCAD)Courtesy of Dr David Cunningham (CCAD)

Courtesy of Dr David Cunningham (CCAD)Courtesy of Dr David Cunningham (CCAD)

Courtesy of Dr David Cunningham (CCAD)Courtesy of Dr David Cunningham (CCAD)

Courtesy of Dr David Cunningham (CCAD)Courtesy of Dr David Cunningham (CCAD)

Courtesy of Dr David Cunningham (CCAD)Courtesy of Dr David Cunningham (CCAD)

Timetable 2005Timetable 2005

• FebruaryFebruary– Working Group meets to consider:Working Group meets to consider:

• Expressions of interest & potential fundingExpressions of interest & potential funding• Dataset and data collection systemDataset and data collection system• Final revision of scoping documentFinal revision of scoping document

– SDO invites tenders (up to £250k) from research units to undertake:SDO invites tenders (up to £250k) from research units to undertake:• Assessment of patient and carer experience• Workforce implications• Description of different models of service delivery• Assessment of potential implementation and feasibility• Economic evaluation

• AprilApril– Proposed start of pilot projectProposed start of pilot project– Establish Steering Group and Data Monitoring GroupEstablish Steering Group and Data Monitoring Group

ConclusionsConclusions

• Welcome feasibility exercise (2 years)Welcome feasibility exercise (2 years)– Assessment of costsAssessment of costs– Identification of cost savingsIdentification of cost savings– Observation of outcomesObservation of outcomes

• Centres selectedCentres selected– Perceived likelihood of data deliveryPerceived likelihood of data delivery– Requirement for different service models & geographical spreadRequirement for different service models & geographical spread– Centres not centrally funded for data collection can still participate if Centres not centrally funded for data collection can still participate if

meet scoping criteriameet scoping criteria

• Project should not be used to inhibit local service developmentsProject should not be used to inhibit local service developments