Participation in heart disease audits
National clinical audits are intended to have national coverage and are designed to improve patient outcomes across a wide range of medical, surgical, and mental health conditions. Their purpose is to engage all healthcare professionals in systematic evaluation of their clinical practice against standards and to support and encourage improvement in the quality of treatment and care.
In July 2009 the National Clinical Audit Advisory Group (NCAAG) published their first annual report, where it defined the aim of clinical audit as a means to both stimulate quality improvement interventions and to assess their impact. The establishment of the NCAAG built on the white paper, ‘Trust, Assurance and Safety - The Regulation of Health Professionals in the 21st Century (February 2007)', where the government agreed with the Chief Medical Officer that a wide and inclusive clinical audit advisory group should be established in England to drive the further development of local and national clinical audit programmes.
Currently there are 6 national cardiac audits which relate to the acute and specialist trusts which are listed below. National audits:
The Myocardial Ischaemia National Audit Project (MINAP) allows clinicians to examine the management of myocardial infarction (heart attacks) and other acute coronary syndromes.
BCIS Angioplasty Audit which aims to improve the care of patients who undergo percutaneous coronary intervention (PCI) procedures. The audit provides a mechanism to collect procedure-specific data.
The Adult Cardiac Surgery Audit aims to improve the quality of care for cardiac patients by comparing local hospital performance and understanding clinical trends within cardiac surgery in the UK.
The Cardiac Rhythm Management Audit aims to monitor the use of implantable devices and interventional procedures for management of cardiac rhythm disorders in UK hospitals.
The Congenital Heart Disease Audit aims to monitor care and provide national analysis of outcomes of cardiac surgery and therapeutic cardiac catheterisation procedures in people with congenital heart disease.
The Heart Failure Audit aims to improve the quality of care for patients with heart failure, by assessing variation in the diagnosis and treatment across the country, and the positive effect on patient outcomes.
This part of the indicator will assess the completeness of data and will be scored on a five point scale (0 - 4), scoring one point for answering 'Yes' and zero for 'No' for each of the questions listed below.
a) whether a trust has greater than or equal to 90% completion in each of the key fields in MINAP, listed below. The data completeness analysis will be based on records with a discharge diagnosis of MI non ST elevation and acute coronary syndrome (troponin positive) without ST segment elevation.
1.03 NHS number
1.11 GP/PCT code
2.02 Method of admission
2.03 ECG determining treatment
2.14 Cardiac markers raised
2.16 Smoking status
2.26 Previous drug use Statin
3.06 D/T arrival in hospital
4.01 Date of discharge
4.02 Discharge diagnosis
4.03 Bleeding complications
4.04 Death in hospital
4.06 Discharged on ACEI/ARB
4.13 Coronary angio
4.16 Discharge destination
4.27 Discharged on a thienopyridine inhibitor
b) whether a trust achieved an agreement score of at least 80% as part of the 2009 MINAP data validation exercise. Evidence of participation in audit will be based on validation of a minimum of 15 records in the MINAP annual data validation study.
c) whether a trust that provides PCI procedures participated in the BCIS-CCAD audit project with the uploading of individual procedural data to the Central Cardiac Audit Database (CCAD) servers.
d) whether a trust that provides PCI procedures has greater than or equal to 90% completion for each of the key fields recorded by the BCIS-CCAD audit project. The key fields are:
1.03 NHS number
1.06 Date of birth
2.03 Procedure urgency
2.04 Pre-procedure shock
3.09 Vessels treated
4.01 PCI hospital outcome
4.03 Discharge status
4.04 Discharge date
5.05 Medical history
5.06 Renal disease
This part of the indicator will assess trust participation in the following audits:
a) adult cardiac surgery audit
b) cardiac rhythm management audit
c) congenital heart disease audit
d) heart failure audit
Trusts will be deemed to have participated in an audit if they have systems and processes in place to submit data via the appropriate data collection method and have used this method to submit data. Trusts must have continuously submitted data for the audits once participation has commenced.
These measures will be combined into a matrix to determine a final score.
Trusts should be participating in audits where the associated procedures are carried out. For example, all trusts carrying out congenital procedures should be participating in the congenital heart disease audit.
For the 2009/10 assessment year we will be assessing trust participation in the following audits: adult cardiac surgery audit, cardiac rhythm management audit, heart failure audit and congenital heart disease audit. Future assessment years may see trusts being assessed against the completeness of their data within these audits. There is also scope for other new or existing heart disease audits to be included within future assessments.
The Care Quality Commission is aware that participation is defined by the heart failure audit as 20 cases per month from July 2009, increasing from 10 cases prior to this date. The Care Quality Commission would expect trusts to participate fully in the audit and will reconsider its thresholds in future years’ assessments.
Please note that data quality will be assessed. Services should be aware that if data are not of sufficient quality they will be penalised. For further details on data quality and timeliness please see our website (opens new window).
Data source and period
Adult Cardiac Surgery Audit (financial year 2009/10)
British Cardiovascular Intervention Society National Audit (calendar year 2009)
Cardiac Rhythm Management Audit (calendar year 2009)
Congenital Heart Disease Audit (financial year 2009/10)
Heart Failure Audit (financial year 2009/10)
Myocardial Ischaemia National Audit Project (financial year 2009/10)