Hjärtsjukvårdens Nationella Kvalitetsregister. Per Albertsson. Ordförande Sektorsrådet i Hjärtsjukvård

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1 Hjärtsjukvårdens Nationella Kvalitetsregister Per Albertsson. Ordförande Sektorsrådet i Hjärtsjukvård

2 Web-plattform Personnummerbaserat (Samkörning PAR, Dödsorsaksregistret, övriga kvalitetsregister o.s.v) Fylls i online (i bästa fall) av olika personalkategorier (Medicinska sekreterare, sjuksköterskor, läkare)

3 NATIONELLA KVALITETREGISTER SWEDEHEART Pacemakerregistret Hjärtstoppsregistret Riks-svikt PAH-registret Auricula (Förmaksflimmer) SWEDEHEART= RIKS-HIA SCAAR Hjärtkirurgiregistret SEPHIA TAVI Ablacure (Ablationer)

4 190 variabler

5 Vad används register till Verksamhetsstyrning Intern Kvalitetskontroll i realtid Öppna jämförelser/regionala måltal Produktionsuppföljning Kontroll vid fakturering Forskning Utbildning (Fallbeskrivningar m.m.)

6 Kvalitetskontroll i realtid

7 Kvalitetsindex: Akuta åtgärder vid hjärtinfarkt

8 Kvalitetsindex: Akuta åtgärder vid hjärtinfarkt 8

9 Kvalitetskontroll i realtid

10 Kvalitetsindex: Akuta och sekundärpreventiva Åtgärder vid hjärtinfarkt

11 11 Presentationens namn Verksamhetsstyrning

12 FORSKNING

13 Forskning och betydelse för budget; Västra Götaland 1.6 million inhabitants, 17 % of the Swedish population Data from the SCAAR registry (Swedish Coronary Angiography and Angioplasty Registry) Consecutive PCI PCI hospitals ~20 % of all data in SCAAR

14 RESULTS Propensity score adjusted Cox proportional hazards regression HR = 0.63, 95% CI , P <0.001

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16 Heparin versus bivalirudin in patients with non ST-elevation acute coronary syndrome undergoing percutaneous coronary intervention - a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) Oskar Angerås 1, Sasha Koul 2, Måns Söderbom 3, Per Albertsson 1, Truls Råmunddal 1, Göran Matejka 1, Fredrik Scherstén 2, Jonas Oldgren 4, Stefan James 4, Bo Lagerqvist 4, Ole Fröbert 5, Hans Wedel 6, David Erlinge 2, Elmir Omerovic 1 1 Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden 2 Department of Cardiology, Lund University, Lund, Sweden 3 Department of Economics, University of Gothenburg, Gothenburg, Sweden 4 Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden 5 Department of Cardiology, Örebro University Hospital, Örebro, Sweden 6 Nordic School of Public Health, Gothenburg, Sweden

17 Results A d ju s te d o d d s r a tio d a y m o r ta lit y C o m pl e te ca s e Im pu te d da ta s e t 1.35 In s tru m e n ta l va ri a bl e F a v o u r s b iv a lir u d in F a v o u r s h e p a r i n

18 Anticoagulation therapy during PCI -- The rise and fall of bivalirudin at Sahlgrenska University Hospital Angerås O. 1, Völz S. 1, Odenstedt J. 1, Råmunddal T. 1, Petursson P. 1, Ioanes D. 1, Haraldsson I. 1, Dworeck C. 1, Libungan B. 1, Albertsson P. 1, Omerovic E. 1 1 Department of Cardiology, Sahlgrenska University Hospital, GOTHENBURG Background Bivalirudin has been shown superior to heparin and glycoprotein IIb/IIIa receptor inhibitors (GP IIb/IIIa) during percutaneous coronary intervention (PCI) in randomized studies of patients with acute coronary syndrome (ACS), i.e. ST segment elevation myocardial infarction (STEMI) and non-stemi. However recently, studies comparing bivalirudin to heparin in both non-stemi and STEMI have been presented questioning the superiority of bivalirudin ragarding mortality. This abstract aim to describe the usage of bivalirudin in patients with ACS undergoing PCI in one large centre in Sweden, Sahlgrenska University Hospital (SU), Gothenburg. Methods Data on patients, anticoagulation therapy used and reported complications was collected from SCAAR (Swedish Coronary Angiography and Angioplasty Registry). PCI procedures performed January 2010 January 2015 due to ACS were included in the analysis. Reported in-hospital bleeding events and 30 day mortality was analyzed for each year during the study period with logistic regression adjusted for indication, age, gender, prior myocardial infarction, prior PCI, prior CABG, treated hypertension, treated hyperlipidemia, vascular access site, cardiogenic chock and treatment of oral platelet inhibition prior to PCI. 100 Results Between 2010 and january 2015, 5,760 PCI procedures were performed in patients with ACS at SU. Bivalirudin was used as the primary anticoagulant in 3,302 procedures and heparin in 2,434 procedures. Background and procedural data is shown in table 1. A switch in anticoagulation strategy was seen from bivalirudin to heparin alone, see figure 1. In 2012 there were significantly less reported in-hostpital events than the other years during the period, see table 2. No difference was seen in 30 day mortality, data not shown. Heparin Conclusion In this single centre observational study, a treatment switch was seen from bivalirudin as the primary anticoagulation treatment to heparin alone from 2010 to 2015 with no negative impact on clinical events. Anticoagulation theparpy used (%) Table 1. Bivalirudin (n=3,302) Age (mean) Female (%) Heparin (n=2,434) GPIIb/IIIa Bivalirudin Pretreated ASA (%) Pretreated P2Y12- inhibitor (%) Radial access site (%) Indication (%) m1 2011m1 2012m1 2013m1 2014m1 2015m1 Unstable angina 8 22 Non-STEMI STEMI Use of heparin (%) Use of GPIIb/IIIainhibitor (%) Cardiogenic shock (%)

19 Revision/ Kvalitetskontroll Hjärtinfarktvården granskas ur ett genusperspektiv Samarbete med kunskapscentrum för jämlik vård

20 Sannolikhet att förskrivas rekommenderad behandling

21 Långtidsmortalitet (kvinna vs man)

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23 K-M estimated rate (% per year) All cause mortality 7 6 Clopidogrel Ticagrelor HR 0.82 (95% CI = ), p= No. at risk Months Ticagrelor 4,2014,005 3,962 3,876 3,150 2,413 1,993 Clopidogr 4,2294,029 3,989 3,912 3,195 2,471 1,980 el

24 Instrumental variabel analys ticagrelor vs. clopidogrel RIKS HIA Number of clusters (centreid_dc) = 97 Number of obs = F( 18, 96) = Prob > F = Total (centered) SS = Centered R2 = Total (uncentered) SS = 3054 Uncentered R2 = Residual SS = Root MSE =.1574 Ticagrelor N=21550 Clopidogrel N=82920 Risk reduktion per 100 patienter = 0.13% Robust d_dead_30 Coef. Std. Err. z P> z [95% Conf. Interval] tica d_age_hia d_gender d_diabetes _Ismoking_s_ _Ismoking_s_ _Ismoking_s_ _Id_diagrup_ d_resuscitated_cardiac_arrest previous_mi previous_pci previous_stroke beta_blockers_discharge d_ace_a2_discharge statins_discharge aspirin_discharge d_pci cardiac_shock _cons

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