QUALITY 1990 until today
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Transcript of QUALITY 1990 until today
Volker Mühlberger, QualityVolker Mühlberger, Quality
QUALITY 1990QUALITY 1990until today until today
Österreichische Kardiologische Gesellschaft
Arbeitsgruppe Interventionelle Kardiologie
Volker Mühlberger, QualityVolker Mühlberger, Quality
AUSTRIA 2002 AUSTRIA 2002
Monitor ReportMonitor Report
W.KleinW.Klein P.ProbstP.Probst F.LeischF.Leisch V.MühlbergerV.Mühlberger
Volker Mühlberger, QualityVolker Mühlberger, Quality
EUROPEAN + AUSTRIAN EUROPEAN + AUSTRIAN ANGIOGRAPHY + PTCAANGIOGRAPHY + PTCA
QUALITY REPORTQUALITY REPORT
Europa
Volker Mühlberger, QualityVolker Mühlberger, Quality
AUSTRIAN ANGIOGRAPHY AUSTRIAN ANGIOGRAPHY +/- PTCA- CENTERS 2001 +/- PTCA- CENTERS 2001
4 Pediatric 4 Pediatric 31 Adult 31 Adult ((7 7 in Vienna)in Vienna)
Rooms (n=39)Rooms (n=39) (37 PTCA, 2 CAG)(37 PTCA, 2 CAG)
Volker Mühlberger, QualityVolker Mühlberger, Quality
AUSTRIA 2000/2001AUSTRIA 2000/2001
� AngiographyAngiography 35.558 38.71435.558 38.714
� PTCA=PCI 10.469 12.053PTCA=PCI 10.469 12.053
� stentstent 76% 81% 76% 81%
� CABG-OPCABG-OP 3.4413.441
� Vitium + Vitium +
� CABG-OP 621CABG-OP 621
Volker Mühlberger, QualityVolker Mühlberger, Quality
Coronary Angiography Frequency per Coronary Angiography Frequency per One Million Inhabitants in AU(8.06)/CH(7.18)One Million Inhabitants in AU(8.06)/CH(7.18)
7239
0
2000
4000
6000
800019
92
1994
1996
1998
2000
AU 8.06
CH 7.18
D 82.16
Volker Mühlberger, QualityVolker Mühlberger, Quality
PTCA Frequency per One Million PTCA Frequency per One Million Inhabitants in Austria / SwitzerlandInhabitants in Austria / Switzerland
2194
0
500
1000
1500
2000
2500
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
AU
CH
D
Volker Mühlberger, QualityVolker Mühlberger, Quality
RATIO PCI/CA (%) YEARS 2000/2001RATIO PCI/CA (%) YEARS 2000/2001 ALL AUSTRIAN CENTERSALL AUSTRIAN CENTERS
Prozentanteil von PCI bezogen auf Anzahl der diagnostischen Angiographien in den 31 Zentren in Österreich (Vergleich 2000/2001)
0
10
20
30
40
50
60
70
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
PCI-Zentrum Nr 1-26 (2000) und 1-29 (2001)
% P
CI/
CA JAHR 2000
JAHR 2001
Volker Mühlberger, QualityVolker Mühlberger, Quality
%-PTCA during Diagnostic %-PTCA during Diagnostic Angio in Austria/SwitzerlandAngio in Austria/Switzerland
0
10
20
30
40
50
60
70
80
90
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
AU
CH
Volker Mühlberger, QualityVolker Mühlberger, Quality
Ratio of (CABG-OP+PTCA) per Ratio of (CABG-OP+PTCA) per Angiography in Austria / SwitzerlandAngiography in Austria / Switzerland
4148 40
50
39
51
39
48
40
51
40 40
0
10
20
30
40
50
601992
1993
1994
1995
1996
1997
1998
1999
2000
2001
AU
CH
Volker Mühlberger, QualityVolker Mühlberger, Quality
PTCA Hospital-Mortality (%) in PTCA Hospital-Mortality (%) in Austria and SwitzerlandAustria and Switzerland
00,10,20,30,40,50,60,70,80,9
1
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
AU
CH
Volker Mühlberger, QualityVolker Mühlberger, Quality
Ratio of STENTING per PTCA Ratio of STENTING per PTCA (%)in Austria and Switzerland(%)in Austria and Switzerland
0
10
20
30
40
50
60
70
80
90
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
AU
CH
Volker Mühlberger, QualityVolker Mühlberger, Quality
Ratio of emergency CABG due Ratio of emergency CABG due to PTCA (%) in Austria/Switzerlandto PTCA (%) in Austria/Switzerland
0
0,2
0,4
0,6
0,8
1
1,2
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
AU
CH
Volker Mühlberger, QualityVolker Mühlberger, Quality
EMERGENCY CABG AFTEREMERGENCY CABG AFTER PCI PCI (%)-MORTALITY in Austria(%)-MORTALITY in Austria
3,3
8,3
18,2
28,6
8,3
15,4 16
25
32
0
5
10
15
20
25
30
35
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Volker Mühlberger, QualityVolker Mühlberger, Quality
Acute Myocardial Infarction (%) after Acute Myocardial Infarction (%) after PTCA in Austria and SwitzerlandPTCA in Austria and Switzerland
00,20,40,60,8
11,21,41,61,8
2
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
AU
CH
Volker Mühlberger, QualityVolker Mühlberger, Quality
PTCA for acute Myocardial Infarction PTCA for acute Myocardial Infarction (%) in Austria and Switzerland(%) in Austria and Switzerland
0
2
4
6
8
10
12
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
AU
CH
Volker Mühlberger, QualityVolker Mühlberger, Quality
PCI FOR =PCI FOR = DURING ACUTE MIDURING ACUTE MI(%)-MORTALITY in Austria(%)-MORTALITY in Austria
27
2,5
31
2,8
35
2,6
30
2,10
5
10
15
20
25
30
35
1998 1999 2000 2001
PCI forMI+Shock
PCI for MIwithoutShock
Volker Mühlberger, QualityVolker Mühlberger, Quality
% GP IIb/IIIa for PTCA% GP IIb/IIIa for PTCA
0
5
10
15
20
25
1996 1997 1998 1999 2000 2001
AustriaSwitzerland
Volker Mühlberger, QualityVolker Mühlberger, Quality
Puncture site closing devices Puncture site closing devices (% of PCI)(% of PCI)
19
23
0
5
10
15
20
25
30
35
1998 1999 2000 2001
AUSTRIASWISS
Volker Mühlberger, QualityVolker Mühlberger, Quality
Brachial and Radial Approach %Brachial and Radial Approach %
0
0,5
1
1,5
2
2,5
3
3,5
1999 2000 2001
AUCH
Volker Mühlberger, Quality 96/97Volker Mühlberger, Quality 96/97
NEW DEVICES, AustriaNEW DEVICES, Austria
1992
1994
1996
1998
2000
LASER
ROTABL
IIb/IIIa
0
2000
4000
6000
8000
10000
LASER
DCA
ROTABL
IVUS
IIb/IIIa
STENT
Volker Mühlberger, QualityVolker Mühlberger, Quality
OTHER NEW DEVICESOTHER NEW DEVICES Austria 2001Austria 2001
Brachytherapie 101Brachytherapie 101 Ultraschalltherapie 11Ultraschalltherapie 11 Gerinnselentferner 45Gerinnselentferner 45 Transmyokardialer Laser 16Transmyokardialer Laser 16 Spinal Cord Stimulation 3Spinal Cord Stimulation 3 Alkoholablation 3Alkoholablation 3 Defektverschlüsse 100Defektverschlüsse 100
Volker Mühlberger, QualityVolker Mühlberger, Quality
Case load per physicianCase load per physician
0
50
100
150
200
250
1998PCI
1999PCI
2000PCI
2001PCI
1998KAG
1999KAG
2000KAG
2001KAG
AUSTRIA
SWISS
Säule (3D) 3
Volker Mühlberger, QualityVolker Mühlberger, Quality
NUMBER OF CENTERS WITH HIGH OR NUMBER OF CENTERS WITH HIGH OR LOW CASE LOAD FOR PCI DURING 2000LOW CASE LOAD FOR PCI DURING 2000
0
2
4
6
8
10
12
<200 PCI per yearand center
200-400 >400 PCI
AUCH
Volker Mühlberger, QualityVolker Mühlberger, Quality
NUMBER OF CENTERS WITH HIGH OR NUMBER OF CENTERS WITH HIGH OR LOW CASE LOAD FOR CA DURING 2000LOW CASE LOAD FOR CA DURING 2000
0
2
4
6
8
10
12
14
<400 CA peryear and
center
400-1000 1000-2000 >2000 CA
AUCH
Volker Mühlberger, QualityVolker Mühlberger, Quality
AUSTRIA (8.06 million inhabitants) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Coronary angiography (CA) per million inhabitants (n) 2351 2721 2637 2996 3296 3726 3927 4082 4417 4803
PTCA per million inhabitants (n) 472 533 617 737 838 951 1070 1152 1300 1495
Ratio of (CABG+PTCA) per CA (%) 36 36 40 41 40 39 39 40 40 40
PTCA during diagnostic CA (%) 39 50 48 50 55 61 70 72 77 78
Ratio of PTCA for ongoing myocardial infarction (%) 1,7 1,8 2,3 2,8 5,1 3,9 5,5 9,1 11,0 9,2
Ratio of hospital mortality after PTCA (%) 0,5 0,5 0,5 0,5 0,6 0,6 0,5 0,6 0,66 0,61
Ratio of myocardial infarction due to PTCA (%) 1,9 1,2 1,4 1,3 1,1 0,9 0,9 0,8 1,5 1,6
Ratio of emergency CABG due to PTCA (%) 0,9 0,7 1,2 0,8 0,4 0,3 0,2 0,3 0,15 0,16
Ratio of stenting in PTCA (%) 2,4 4,3 8,9 27 47 58 68 74 76 81
Volker Mühlberger, QualityVolker Mühlberger, Quality
WITZERLAND7.18 million inhabitants)
1992 1993 1994 1995 1996 1997 1998 1999
ronary angiography (CA) per million inhabitants (n) 2110 2602 3031 3307 3508 3632 4000 3900
CA per million inhabitants (n) 462 665 822 959 1102 1241 1366 1355
tio of (CABG+PTCA) per CA (%) 48 50 50 48 50 51 48 51
CA during diagnostic CA (%) 43 39 51 59 60 74 77 83
tio of PTCA for ongoing myocardial infarction (%) 3,1 3,3 4,4 6,0 6,1 6,8 8,0 10
tio of hospital mortality after PTCA (%) 1,0 0,6 0,6 0,6 0,7 0,6 0,6 0,9
tio of myocardial infarction due to PTCA (%) 1,8 1,2 1,2 1,1 1,1 1,2 1,2 1,5
tio of emergency CABG due to PTCA (%) 1,2 0,8 0,9 0,7 0,4 0,3 0,2 0,3
tio of stenting in PTCA (%) 3,6 6,0 15 28 50 57 67 73
STAND 02/01