1. Why have a national database? Ben Bridgewater Cardiac surgeon and lead clinician, UHSM, Manchester Honorary Reader, Manchester University and Manchester Academic Health Science Centre Clinical Lead for SCTS, NICOR, UCL Chair SCTS database committee Chair EACTS database committee

2. Monitoring trends Supporting quality improvement Clinical governance Tracking new procedures Research substrate What we do

3. Supporting shared decision making for patients Improving overall quality Advancing knowledge Improving the reputation of cardiac surgery Increasing the profile and influence of the professional society Benefits

4. Trends SCTS database – approx 500,000 records Blue Book in 2009 Next Blue book in preparation Comprehensive analysis of trends and outcomes in cardiac surgery www.scts.org

5. Trends in cardiac surgery –Activity

6. Trends in cardiac surgery –Activity –Casemix

7. Trends in cardiac surgery –Activity –Casemix –Risk factors

8. Trends in cardiac surgery –Activity –Casemix –Risk factors

9. Trends in cardiac surgery –Activity –Casemix –Risk factors –Outcomes - mortality

10. Trends in cardiac surgery –Activity –Casemix –Risk factors –Outcomes - mortality

11. Trends in cardiac surgery –Activity –Casemix –Risk factors –Outcomes – mortality –Outcomes - other

12. Trends in cardiac surgery –Activity –Casemix –Risk factors –Outcomes – mortality –Outcomes – other –Techniques

13. Trends in cardiac surgery –Activity –Casemix –Risk factors –Outcomes – mortality –Outcomes – other –Techniques

14. Quality Improvement Mortality analyses Other analyses

15. CABG clinical outcomes Mortality Survival In-hospital complications Length of stay Angina recurrence

20. Clinical Governance Risk adjusted mortality rates

21. Results

22. Explanation of divergence

23. What does it take to trigger?

24. Tracking new procedures SCTS in conjunction with British Cardiac Interventional Society All TAVIs since introduction in UK Agreed dataset Data validated Long term mortality tracking In conjunction with (and funded by) commissioners of healthcare

25. Improving the reputation of cardiac surgery

27. Increasing profile and Influence of professional society Maintaining Patients launched by the Right Honourable Andrew Lansley, Secretary of State for Health at the SCTS annual meeting in March 2011 NHS paper June 08 Policy Paper A5 www.conservatives.com/~/media/files/.../health_policy_paper.ashx?dl=true NHS Improvement plan Houses of Parliament, Early Day Motion 1104. 30.11.10 www.conservatives.com/~/media/Files/.../NHS_improvement_plan.ashx?dl http://news.bbc.co.uk/1/hi/health/8170618.stm http://news.bbc.co.uk/today/hi/listen_again/default.stm,http://news.bbc.co.uk/today/hi/listen_again/default.stm http://www.dailymail.co.uk/health/article-1203097/Women-heart-patients-twice-likely-die-men.html http://www.guardian.co.uk/lifeandstyle/2009/jul/30/heart-surgery-death-rates-fall?INTCMP=SRCH http://www.telegraph.co.uk/health/healthnews/5935355/Death-rate-among-heart-surgery-patients- is-falling.htmlhttp://www.telegraph.co.uk/health/healthnews/5935355/Death-rate-among-heart-surgery-patients- is-falling.html http://www.bbc.co.uk/news/health-11831159 http://www.telegraph.co.uk/health/healthnews/8156487/England-has-best-heart-surgeons-in- Europe-report.htmlhttp://www.bbc.co.uk/news/health-11831159 http://www.telegraph.co.uk/health/healthnews/8156487/England-has-best-heart-surgeons-in- Europe-report.html http://www.guardian.co.uk/uk/2010/nov/25/nhs-heart-surgeons-low-mortality http://www.walesonline.co.uk/news/wales-news/2010/11/25/wales-leading-the-way-in-heart- bypass-survival-rates-91466-27711979/,http://www.walesonline.co.uk/news/wales-news/2010/11/25/wales-leading-the-way-in-heart- bypass-survival-rates-91466-27711979/ http://topnews.us/content/229260-uk-bypass-surgeries-show-excellent-survival-rates

28. Research substrate Methods of risk stratification –Validating existing models –Developing new models Clinical Hypothesis testing –BIMA vs SIMA clinical outcomes –On-pump vs Off pump surgery –Late outcomes depending on prosthesis choice Health service research –Volume outcomes association

32. Supporting shared decision making for patients Improving overall quality Advancing knowledge Improving the reputation of cardiac surgery Increasing the profile and influence of the professional society Benefits

33. Thanks for listening Any questions?