PCI Models: Gloucestershire

Nick WestConsultant Cardiologist

MY CONFLICTSOF INTEREST ARE:

Advisory Board: Nycomed, Astrazeneca, Schering-Plough

Speaker Fees: Nycomed, Astrazeneca, Schering Plough, MSD

Sponsorship: Boston Scientific, Nycomed, Medtronic, Abbott Vascular

Research Grants: Bristol-Myers Squibb

Glos Hosps NHS Foundation Trust

• 650,000 population• 2 DGHs• 2 Cath labs• 3 Interventionalists

• Remote from Tertiary centres

Who should go to a surgical centre?

Viewpoints: Patients Trusts Cardiologists

A local service

0

100

200

300

400

500

600

2002/03 2003/04 2004/2005 2005/2006 2006/2007

Out of countyIn-county

PCI in Gloucestershire:Inpatient vs. Elective work.

Cas

es/y

ear (

n)

Possible issues

Out-of-hours/on-callSpecialist techniques/devices‘High risk’ casesResearch studies

Out of hours/on-call

Can your service offer PCI 24/7?Are you geared up for emergencies?How many interventionalists are there?Is there an on-call rota?Do the rest of the cath lab staff want this?Is it cost-effective?

Network solutions

What is ‘high risk’?

0

100

200

300

400

500

600

2002/03 2003/04 2004/2005 2005/2006 2006/2007

Out of countyUrgent PCIElective PCI

PCI in Gloucestershire:Inpatient vs. Elective work.

Cas

es/y

ear (

n)

1.2

1.6

1.3

0.0

0.5

1.0

1.5

2.0

CGH RBH NWQIP

How do we measure up?

1.2

0.4

1.6

0.4

1.3

0.0

0.5

1.0

1.5

2.0

CGH RBH NWQIP

Inho

spita

l MA

CE

(%)

Grayson et al. Heart 2006; 92: 658-663

Research Studies

Should offsite centres be allowed to join in?

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E-5 Registry: the ‘Real World’E-5 Registry: the ‘Real World’

Final UK recruitment:Final UK recruitment:

Cheltenham GeneralCheltenham General 100 100Leeds GeneralLeeds General 6565Royal Victoria, BelfastRoyal Victoria, Belfast 5151St. Georges, London St. Georges, London 4646James Cook, M’boro James Cook, M’boro 3636QE, BirminghamQE, Birmingham 3535Derriford, Plymouth Derriford, Plymouth 1818Barts, LondonBarts, London 1414Nottingham City Nottingham City 1313Walsgrave, Coventry Walsgrave, Coventry 1313London Chest London Chest 1212

PC Biomimetic polymerPC Biomimetic polymerReduced platelet depositionReduced platelet deposition

Rapid and complete drug deliveryRapid and complete drug deliveryHighly lipophillic limus analogueHighly lipophillic limus analogue

Noninflammatory responseNoninflammatory responseand rapid endothelializationand rapid endothelialization**

Possible issues

Out-of-hours/on-callSpecialist techniques/devices‘High risk’ casesResearch studies

?

X

X

X

Summary

Few good arguments to limit offsite work

Can we all live together happily ever after?

Acknowledgements

Rafe Chamberlain-WebberZafar KhanAll cath lab staff at CGH