Scottish Cardiac Audit Programme (SCAP)

About this release

This release by Public Health Scotland (PHS) is the second time the Scottish Cardiac Audit Programme (SCAP) has released data in relation to cardiac interventions undertaken in Scotland. This covers the areas of adult percutaneous coronary intervention (PCI), transcatheter aortic valve implantation (TAVI), adult cardiac surgery and congenital heart disease.

Main points

SCAP have received data submissions up to 2022/23 for the four audit areas. Throughout 2022/23 there were 9,040 PCI, 2,160 adult cardiac surgery, 621 congenital heart disease and 575 TAVI procedures.

Chart showing time trend of all number of procedures included within each audit since 2019/20. SCAP have received data submissions up to 2022/23 for the four audit areas. There were 9,040 PCI, 2,160 adult cardiac surgery, 621 congenital heart disease and 575 TAVI procedures in 2022/23.

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Number of cardiac procedures included within SCAP

PCI summary:

• Linkages with the Unscheduled care datamart has significantly improved the data quality, completeness and understanding of performance for ST elevation myocardial infarction (STEMI) call to balloon time and non ST elevation myocardial infarction (NSTEMI) PCI within 72 hours.
• Only 2 of the 6 NHS Boards within Scotland managed to achieve the target of performing PCI on NSTEMI patients within 72 hours. This may be explained in part by the different models used in some centres but to properly understand the care of this patient group PHS plan to revisit how we measure, report and govern this standard in future reports.
• 71% of patients presenting directly to a PCI centre manage to have their PCI within the target time of 150 minutes from their initial call for help, compared to only 47% of those who present initially to a non PCI centre.

TAVI summary:

• During 2022/23 there were 575 TAVI procedures undertaken in Scotland. This is an increase of 17.8% compared to 488 procedures in 2021/22.
• In 2022/23 Scotland's TAVI rate per million population (PMP) has risen from 89 PMP to 105 PMP, this still sits behind the rest of the UK TAVI rate (113 PMP) for the previous year.
• Complication and mortality rates associated with TAVI remain very low.

Adult cardiac surgery summary:

• No sites have fully recovered from the impact of COVID 19 however they have all recovered by at least 74%.
• Complication rates associated with coronary artery bypass graft (CABG) and surgical aortic valve replacement (SAVR) are all within normal limits in Scotland.
• The majority of adult cardiac surgery being performed in Scotland is for elective patients.

Congenital Heart Disease summary:

• There has been an improvement in prolonged pleural drainage rates within paediatric congenital procedures with 5.4% of patients having this in 2021/2022 and this year there has been a reduction to 3.1%.
• The Royal Hospital for Children, Glasgow (RHC) lies within 2-3 standard deviations from the UK mean in relation to extracorporeal life support use post procedure with 6.7% of patients requiring this. Further analysis by the RHC suggests that the higher instances of extracorporeal life support may be associated with patients requiring this on more than one occasion.

Background

The Scottish Cardiac Audit Programme (SCAP) is part of the Scottish National Audit Programme in PHS. Scottish Government commissioned PHS to establish the development of the SCAP from 1 April 2021. This is to help and support the delivery of Priority 4 of the Heart disease action plan 2021. It states:

Effective use of data: We will ensure that high-quality, standardised data is available and used effectively to support clinical decision-making, understand patient outcomes and enable better service-planning.

The four audits within this release were previously managed by the National Institute for Cardiovascular Outcomes Research (NICOR) as part of an agreement with the Healthcare Quality Improvement Partnership (HQIP) supported by NHS England. These data are now submitted directly to PHS and SCAP reports this information and benchmarks with the NICOR reports with data which are publicly available. SCAP is working closely with the clinical community, service planners and those with lived experience to co-design the future of the audit programme. Areas under development include:

• atrial fibrillation
• hypertension
• heart failure
• coronary artery disease
• cardiac devices and arrhythmia interventions

Further information

The next release of this publication will be 29 October 2024.