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Cardiac Stocktake 2008: Future Needs and Capacity in Northern Ireland

This report assesses future cardiac intervention needs in Northern Ireland, focusing on revascularization and EP/arrhythmia results. It includes projections on angiography, valve surgery, and cardiac surgery, with a population-based evaluation of required capacity.

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Cardiac Stocktake 2008: Future Needs and Capacity in Northern Ireland

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  1. Northern Ireland – Cardiac Stocktake Future Need & Capacity Revascularisation & EP/Arrhythmia Results – 2008 – Final Report Dr Stephen Green – July 2008 Northern Ireland - Cardiac Stocktake 2008

  2. Background • Cardiac stocktake update • Base data updated – • Population Projections, • Mortality Nos. & Rates • 2007/8 Intervention Nos. & Rates • Projections • Projecting future need for angiography revascularisation, valve surgery, other cardiac surgery & EP/Arrhythmia interventions • Assessing capacity required on a population basis Northern Ireland - Cardiac Stocktake 2008

  3. Background 1 • Meeting of Revascularisation Group on 16th May • Changes made • Previously two scenarios for brady pacing – 5% and 10% - reduced to single option 5% • CRT Generator changes – increased to 30% • PVI – include Cath Lab capacity • Cardiac Surgery – • Valves adjusted down to 182 in 2007 • Other Cardiac Surgery adjusted down to 107 in 2007 Northern Ireland - Cardiac Stocktake 2008

  4. Background 2 • Meeting of the Cardiac Network Board – June 2008 • Surgical nos. modelled identified as too low – increased following discussion with Brian Armstrong to 1200 – to include private work which will move to being NHS work as waiting times reduce • PCI - % in Local/Specialist Settings – • previous modelling based on 50% local/50% specialist • added second scenario of 90% local/10% specialist at request of commissioners. This is because some local centres plan already to undertake 90% of the PCIs required for the catchment population Northern Ireland - Cardiac Stocktake 2008

  5. Revascularisation Northern Ireland - Cardiac Stocktake 2008

  6. MODELLING FUTURE INTERVENTION NUMBERS & CATH LAB & CARDIAC THEATRE CAPACITY FOR REVASCULARISATION Modelled intervention rates of 1900, 2200 & 2500 pmp by the year 2015 & ratio of 1.9 Angios per Revasc Relative mortality rates in 10 yr age/sex bands is a proxy for need for revascularisation Assumptions about: STEP 3 Weight HSSB population projections by national age/sex intervention rates & relative mortality STEP 2 Calculate relative mortality for 10 yr age/sex groups by comparing national rate with local rate STEP 1 Calculate national Intervention rates by 10 yr age/sex groups for Revascularisation STEP 4 Calculate Numbers of Revascularisations & Angiograms for the years 2008, 2010, 2015 STEP 5 Split revascularisations between CABG & PCI STEP 6 Calculate Additional Cases for Primary PCI to quantify “in hours” interventions STEP 7 Split workload between Secondary & Tertiary settings STEP 8 Convert workload into Cath Lab & Cardiac Theatres equivalents in secondary & tertiary settings Future ratios of PCI: CABG – with stable CABG numbers Future STEMI numbers, STEMI already receiving PCI, % requiring 2nd PCI and % of cases out of hours % of interventions in secondary & tertiary settings Annual availability of cath labs, lost time, procedure times & throughput Northern Ireland - Cardiac Stocktake 2008

  7. Northern Ireland - Cardiac Stocktake 2008

  8. Population by Trust Area – Mid Year Estimates - 1997-2006 and Projections - 2008, 2010 & 2015 Northern Ireland - Cardiac Stocktake 2008

  9. Northern Ireland - Coronary Heart Disease Number of Deaths by Age – 1997-2006 Northern Ireland - Cardiac Stocktake 2008

  10. Northern Ireland - Coronary Heart Disease Death Rate per 100,000 by Age Group – Females & Males – 1997-2006 Northern Ireland - Cardiac Stocktake 2008

  11. Trust Areas - Coronary Heart Disease Death Rate per 100,000 – Age 45-54 – Females & Males – 1997-2006 Northern Ireland - Cardiac Stocktake 2008

  12. Trust Areas - Coronary Heart Disease Death Rate per 100,000 – Age 55-64 – Females & Males – 1997-2006 Northern Ireland - Cardiac Stocktake 2008

  13. Trust Areas - Coronary Heart Disease Death Rate per 100,000 – Age 65-74 – Females & Males – 1997-2006 Northern Ireland - Cardiac Stocktake 2008

  14. Trust Areas - Coronary Heart Disease Death Rate per 100,000 – Age 75-84 – Females & Males – 1997-2006 Northern Ireland - Cardiac Stocktake 2008

  15. Trust Areas - Coronary Heart Disease Death Rate per 100,000 – Age 85 plus – Females & Males – 1997-2006 Northern Ireland - Cardiac Stocktake 2008

  16. Trust Areas - Coronary Heart Disease - Death Rate per 100,000 – 5 Age Bands – Females & Males – 2003-2006 Combined Northern Ireland - Cardiac Stocktake 2008

  17. Trust Areas - Coronary Heart Disease - Death Rate per 100,000 – 5 Age Bands – Females & Males – 2003-2006 Combined Northern Ireland - Cardiac Stocktake 2008

  18. Northern Ireland & England - Coronary Heart Disease - Death Rate per 100,000 – 5 Age Bands – Females & Males – 2003-2006 Combined Northern Ireland - Cardiac Stocktake 2008

  19. Northern Ireland & England - Coronary Heart Disease - Death Rate per 100,000 – 5 Age Bands – Females & Males – 2003-2006 Combined Northern Ireland - Cardiac Stocktake 2008

  20. Trust Areas Compared with Northern Ireland- Coronary Heart Disease - Death Rate per 100,000 – 5 Age Bands – Females & Males – 2003-2006 Combined Northern Ireland - Cardiac Stocktake 2008

  21. Northern Ireland Compared with England - Coronary Heart Disease - Death Rate per 100,000 – 5 Age Bands – Females & Males – 2003-2006 Combined England = 100% Overall – weighting for age - the NI mortality rates are 14% higher than the England death rates Northern Ireland - Cardiac Stocktake 2008

  22. Weighted Revascularisation Rates3 Scenarios in 2015 Query – are these still plausible? Any signs of levelling off? Northern Ireland - Cardiac Stocktake 2008

  23. Revascularisation – Rates per Million Population - Actual – 2000/01 – 2006/7 & Projected Rates of 1900, 2200 & 2500 by 2015 - England 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 Northern Ireland - Cardiac Stocktake 2008

  24. NI – Projected Nos. of Angiograms – 3 Scenarios – in 2008, 2010 & 2015 Northern Ireland - Cardiac Stocktake 2008

  25. Trust Areas – Projected Nos. of Angiograms – 3 Scenarios – in 2008, 2010 & 2015 Northern Ireland - Cardiac Stocktake 2008

  26. NI – Projected Nos. of PCIs – 3 Scenarios – in 2008, 2010 & 2015 Northern Ireland - Cardiac Stocktake 2008

  27. Trust Areas – Projected Nos. of PCIs – 3 Scenarios – in 2008, 2010 & 2015 Northern Ireland - Cardiac Stocktake 2008

  28. Northern Ireland – Summary of Reported Surgical Activity in 2007/8 Northern Ireland – Baseline Activity N.B. Capacity to undertake all of this activity does not currently exist in the NHS in NI. Northern Ireland - Cardiac Stocktake 2008

  29. NI – Projected Nos. of CABGs, Valves & Other Surgery – One Scenario – in 2008, 2010 & 2015 Valves +5% p.a Other +3% p.a Northern Ireland - Cardiac Stocktake 2008

  30. NI – Projected Nos. of CABGs, Valves & Other Surgery – One Scenario – in 2008, 2010 & 2015 Northern Ireland - Cardiac Stocktake 2008

  31. Assumes Paediatric/Congenital Surgery continues at the Belfast Trust Northern Ireland - Cardiac Stocktake 2008

  32. Assumptions – Local & Specialist/Tertiary Plus new scenario for PCI of 90% local/10% specialist Northern Ireland - Cardiac Stocktake 2008

  33. NI – Projected Nos. Cath Labs for Angio & PCI Combined 3 Scenarios – in 2008, 2010 & 2015 Northern Ireland - Cardiac Stocktake 2008

  34. Cath Labs by Trust Area – Projected Nos. Cath Labs for Angio & PCI Combined - 3 Scenarios – in 2008, 2010 & 2015 Resident Population Modelled Cath Labs Northern Ireland - Cardiac Stocktake 2008

  35. NI – Projected Nos. Cardiac Theatres for 3 Scenarios – in 2008, 2010 & 2015 Northern Ireland - Cardiac Stocktake 2008

  36. EP/Arrhythmia Northern Ireland - Cardiac Stocktake 2008

  37. MODELLING FUTURE INTERVENTION NUMBERS & CATH LAB CAPACITY FOR EP/ARRHYTHMIA Future growth in intervention rates ICD – 216 pmp by 2015 Pacing CRT – 5% & 10% CRT & EP/Ablation – 5%, 10% & 15% Current 5 yr age/sex band intervention rates will continue & 5 yr age/sex intervention rates for ICD are a reasonable proxy for CRT & EP/Ablation Assumptions about: STEP 1 Take national baseline Intervention Rates pmp by 5 yr Age & Sex bands for: Pacing, ICD, CRT, EP/Ablation for England STEP 2 Take Population Projections by 5 yr Age/Sex groups for HSSBs STEP 3 Calculate Numbers of New Cases for future years 2008, 2010, 2015 • STEP 5 • Split workload between • Secondary • Tertiary STEP 6 Convert workload into Cath Lab Equivalents in secondary & tertiary settings & in total STEP 4 Add in Additional Cases for generator changes etc to calculate total interventions % of re-operations & generator changes - BCS % of interventions in secondary & tertiary settings Annual availability of cath labs, lost time, procedure times & throughput Northern Ireland - Cardiac Stocktake 2008

  38. ICD RATES PMP BY AGE – 2002 & 2003 (Source – Personal Comm . David Cunningham) PACING RATES PMP BY AGE – Log Scale - 2002 & 2003 (Source – Personal Comm . David Cunningham) Arrhythmia & Need for EP Services Northern Ireland - Cardiac Stocktake 2008

  39. Northern Ireland - Cardiac Stocktake 2008

  40. EP/ArrhythmiaNew Cases Northern Ireland - Cardiac Stocktake 2008

  41. EP/Arrhythmia - Growth Scenarios Future growth p.a in intervention rates to 2015 ICD – 7.2% Pacing – 5% CRT & EP/Ablation – 5%, 10% & 15% • Low • ICD – 7.2% p.a, Others 5% p.a • Medium • ICD – 7.2% p.a, Pacing 5% p.a, Others 10% p.a • High • ICD – 7.2% p.a, Pacing 5% p.a, EP/Ablation/CRT 15% p.a Northern Ireland - Cardiac Stocktake 2008

  42. New Interventions – per million population Northern Ireland - Cardiac Stocktake 2008

  43. Trust Areas – Population Projections 2008, 2010 & 2015 5 Year Age Bands Used for Arrhythmia Modelling Northern Ireland - Cardiac Stocktake 2008

  44. Trust Areas – Population Projection 2015 5 Year Age Bands Used for Arrhythmia Modelling Northern Ireland - Cardiac Stocktake 2008

  45. New Pacing – Northern Ireland – 5% Growth Scenario 2008, 2010 & 2015 Northern Ireland - Cardiac Stocktake 2008

  46. New Pacing – By Trust Area – 5% Growth Scenario 2008, 2010 & 2015 Northern Ireland - Cardiac Stocktake 2008

  47. New ICD – Northern Ireland – 7.2% Growth Scenario 2008, 2010 & 2015 Northern Ireland - Cardiac Stocktake 2008

  48. New ICD – By Trust Area – 7.2% Growth Scenario 2008, 2010 & 2015 Northern Ireland - Cardiac Stocktake 2008

  49. New CRT – Northern Ireland – 3 Growth Scenarios 2008, 2010 & 2015 Northern Ireland - Cardiac Stocktake 2008

  50. New CRT – By Trust Area – 3 Growth Scenarios 2008, 2010 & 2015 Northern Ireland - Cardiac Stocktake 2008

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