Background

In 1998 the British Cardiovascular Intervention Society (BCIS) started to collect data as a survey. This process has developed so that since 2004, almost all centres performing percutaneous coronary intervention (PCI) in the UK have recorded data about every PCI procedure performed and uploaded them to central servers for analysis and reporting.1

Process

The data are currently collected on behalf of BCIS by the National Institute of Cardiovascular Outcomes Research (NICOR), hosted at Barts Health National Health Service (NHS) Trust, funded by government via the Health Quality Improvement Partnership.

NICOR has harmonised the data collection and analysis across six cardiac domains. PCI is overseen by a group led by the BCIS audit lead, with other interventional cardiologists, analysts, regulatory authorities, NICOR and patient representatives. They maintain the data set, guide analysis reports and oversee proposed research projects.

Data

In 2017, up to 112 of the 118 UK PCI centres uploaded their PCI activity to NICOR, representing 95% of all PCIs. A data set of about 113 fields is collected for each procedure covering all aspects of the PCI up to hospital outcomes. Linkage with postcode allows analyses according to region. In England and Wales, the patient’s NHS number is used to track subsequent life status. An annual survey is also performed to analyse the structure of PCI provision.

Aims

Reports are designed to provide detailed benchmarking of structure, appropriateness, process and outcomes. Risk-adjusted survival is assessed for quality assurance and improvement. In addition, the data are used for observational research.

Data Entry

Data can be entered using a web-enabled interface provided by NICOR, or collected using a local database, encrypted and uploaded by NICOR.

Validation is not possible. However, participation in the audit is publicly reported to encourage compliance. Data are checked for range and internal consistency with an error log generated for each data upload. Prior to the publication, a validation cycle provides every PCI operator their report so that corrections can be made.

Analyses

Annual analyses are created by the audit lead, and made freely available for download from the BCIS website (https://www.bcis.org.uk/resources/audit-results/).

Automated regular reports have been sent to each centre with analyses of their activity, delays to primary PCI and risk-adjusted outcome using process control charts. These are currently being reprogrammed as part of a new information technology (IT) infrastructure.

A new risk prediction model for 30-day survival following PCI was published,2 and a calculator is available on the BCIS website, https://www.bcis.org.uk/resources/pci-risk-calculator/.

PCI has been part of the government’s ‘Consultant Outcome Public’ reports programme. Operator case mix and adjusted 30-day survival is made available to the public for every PCI operator and centre in the UK. These data can be accessed at https://www.bcis.org.uk/patient-area/

Research

This is a large data set of unselected patients with robust mortality tracking, and has thus been able to support a successful programme of observational research.3–7

Future

A new IT platform and updated reporting programme is being implemented to provide more contemporaneous and interactive reports. Linkage to Hospital Episode Statistics and other NICOR domains will improve outputs. The new IT infrastructure should lead to registry-based randomised clinical trials.