Dr Ranjit More

PPCI Lead, LCC

18th September 2012

AGENDA

9: 40 : PPCI – Case Study – Dr Sunita Pillay, Cardiology Spr

9:50: A Cardiac Network Perspective – Kathy Blacker, Director CSNLC

10:00: NWAS Perspective – Mary Peters, Clinical Governance Co-ordinator NWAS

10:20 – 10:45 : Coffee Break

10:45 – 11:00: National Perspective: Dr Jim McLenachan, National Clinical Lead for PPCI

11:00-11:20: Regional PPCI – the first 12 months

11:20-11:45: Rehab for PPCI - Lisa Schofield, Cardiac Rehabilitation Specialist Nurse

PPCI follow-up clinic – Louise Charnley, Nurse Advanced Practitioner

11:45 : Q & A

ST segment elevation MI (STEMI) - Characterised by specific ECG changes due to total occlusion of a coronary artery.

PPCI involves reopening mechanically of the occluded artery by balloon catheter and deployment of a stent

Thrombectomy catheter - Often used, in addition, to aspirate thrombus from the vessel occlusion site

PPCI Procedure Start Mid End result

Reopened Vessel Vessel Occluded in its

Proximal Portion

Benefits of Primary Angioplasty over Thrombolysis

PPCI lowers mortality and improves longer-term symptoms &

outcomes.

• In-hospital mortality for patients undergoing PPCI was 5.2% and

7.1% for those given thrombolysis (NIAP report 2008)

• Also fewer strokes and recurrent heart attacks during the hospital admission

Patients who were admitted directly to the catheter laboratory

bypassing A & E departments had the lowest mortality.

The greatest delay in treatment is the time taken for patients to

recognise the problem and call for help

Therefore need systems in place to minimise delay (TEAM EFFORT:

NWAS, local A& Es, local cardiologists/physicians, public health,

local councils, local press)

Background to regional PPCI Regional PPCI for Lancashire & South Cumbria

planned from 2008

PPCI implementation was an important and integral part of the revascularisation portion of the 5 year strategy for cardiac services of the Cardiac & Stroke Networks in Lancashire and Cumbria

Commissioner sign off for PPCI : end of 2010

Regional PPCI service started June 2011

Detailed modelling done

Ambulance travel time isochrones

PCT financial modelling

Close liaison with NWAS

Additional beds & staff on CCU, wards and cath lab

Local (Blackpool) PPCI

Commenced 2009 : To ensure appropriate infrastructure and systems in place for seamless transition to regional PPCI

Allowed development and modification of protocols for PPCI patients at LCC

NWAS staff to become familiarised with delivering PPCI patients to LCC

PPCI Operational Model Since 5th June 2011 all patients experiencing a STEMI within the network

catchment area are transported straight to the “Heart Attack Centre” at LCC to receive a PPCI. This includes four Acute Trusts across seven geographical sites:

• Royal Blackburn Hospital

• Royal Preston Hospital

• Chorley and South Ribble Hospital

• Royal Lancaster infirmary

• Furness General*

• West Cumberland Hospital

• Blackpool Fylde and Wyre hospitals Foundation Trust • “Drip & Ship” arrangements

A performance target of 150 minutes has been applied to monitor “Call to balloon” time ( NIAP report stipulated that PPCI is a cost effective and appropriate intervention provided PCI related delay is minimised (kept to < 90mins))

PPCI Pathway

* “Drip & Ship” for FGH patients

Patient discharged 72-96 hours after admission.

Call for ambulance / self referral / referred as an inpatient from

DGH.*

Transfer to LCC:

Target <150 minutes from call to Balloon

insertion.

Balloon inserted, patient transferred to Coronary Care Unit.

Patient remains on

Coronary Care Unit, for 6-24 hours

Patient transferred to cardiology wards.

Follow-up: Local hospital

After PPCI procedure

• A “treat and discharge” model of care

• In-patient:

• Advice from CCU nurses & doctors

• Seen by cardiac rehab staff – lifestyle advice

• Pharmacist – medication advice

• On discharge

• Referral to local cardiac rehab service

• PPCI nurse specialist follow-up clinic at approx 2 weeks

• Cardiology clinic follow-up – local

Patient Experience John Stevenson, aged 64 from Lancaster was the first regional patient to

receive a PPCI at Lancashire Cardiac Centre.

“The ambulance crew were called and before I knew it I was in Blackpool having an operation. The speed of the whole process was remarkable,

everyone knew what they were doing and just got on with it, it was like a military operation and everyone involved was outstanding.

I can’t believe I had a heart attack a couple of days ago. I feel so good and I can’t thank everyone at Lancashire Cardiac Centre enough.”

Any Questions