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Temporal trends in relative survival following percutaneous coronary intervention

Temporal trends in relative survival following percutaneous coronary intervention
Temporal trends in relative survival following percutaneous coronary intervention

Objective Percutaneous coronary intervention (PCI) has seen substantial shifts in patient selection in recent years that have increased baseline patient mortality risk. It is unclear to what extent observed changes in mortality are attributable to background mortality risk or the indication and selection for PCI itself. PCI-attributable mortality can be estimated using relative survival, which adjusts observed mortality by that seen in a matched control population. We report relative survival ratios and compare these across different time periods. Methods National Health Service PCI activity in England and Wales from 2007 to 2014 is considered using data from the British Cardiovascular Intervention Society PCI Registry. Background mortality is as reported in Office for National Statistics life tables. Relative survival ratios up to 1 year are estimated, matching on patient age, sex and procedure date. Estimates are stratified by indication for PCI, sex and procedure date. Results 549 305 procedures were studied after exclusions for missing age, sex, indication and mortality status. Comparing from 2007 to 2008 to 2013-2014, differences in crude survival at 1 year were consistently lower in later years across all strata. For relative survival, these differences remained but were smaller, suggesting poorer survival in later years is partly due to demographic characteristics. Relative survival was higher in older patients. Conclusions Changes in patient demographics account for some but not all of the crude survival changes seen during the study period. Relative survival is an under-used methodology in interventional settings like PCI and should be considered wherever survival is compared between populations with different demographic characteristics, such as between countries or time periods.

coronary intervention, quality in health care
2044-6055
1-7
Hulme, William J.
9bfbc023-25cf-4d34-94f3-f06eb932e312
Sperrin, Matthew
e1dd5334-ed19-48c7-b486-024fb03330ba
Martin, Glen Philip
d1533f67-1c77-4075-a3ee-eb18ac499253
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Ludman, Peter
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Kontopantelis, Evangelos
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Mamas, Mamas A.
b71e6a0a-07a4-4822-a10e-c02a6b29ae5d
Hulme, William J.
9bfbc023-25cf-4d34-94f3-f06eb932e312
Sperrin, Matthew
e1dd5334-ed19-48c7-b486-024fb03330ba
Martin, Glen Philip
d1533f67-1c77-4075-a3ee-eb18ac499253
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Ludman, Peter
28ef305d-e09e-40a7-84b4-6ccedfb37cc8
Kontopantelis, Evangelos
0a21ca6f-4516-45f8-80fc-b10dd7db6780
Mamas, Mamas A.
b71e6a0a-07a4-4822-a10e-c02a6b29ae5d

Hulme, William J., Sperrin, Matthew, Martin, Glen Philip, Curzen, Nick, Ludman, Peter, Kontopantelis, Evangelos and Mamas, Mamas A. (2019) Temporal trends in relative survival following percutaneous coronary intervention. BMJ Open, 9 (2), 1-7, [e024627]. (doi:10.1136/bmjopen-2018-024627).

Record type: Article

Abstract

Objective Percutaneous coronary intervention (PCI) has seen substantial shifts in patient selection in recent years that have increased baseline patient mortality risk. It is unclear to what extent observed changes in mortality are attributable to background mortality risk or the indication and selection for PCI itself. PCI-attributable mortality can be estimated using relative survival, which adjusts observed mortality by that seen in a matched control population. We report relative survival ratios and compare these across different time periods. Methods National Health Service PCI activity in England and Wales from 2007 to 2014 is considered using data from the British Cardiovascular Intervention Society PCI Registry. Background mortality is as reported in Office for National Statistics life tables. Relative survival ratios up to 1 year are estimated, matching on patient age, sex and procedure date. Estimates are stratified by indication for PCI, sex and procedure date. Results 549 305 procedures were studied after exclusions for missing age, sex, indication and mortality status. Comparing from 2007 to 2008 to 2013-2014, differences in crude survival at 1 year were consistently lower in later years across all strata. For relative survival, these differences remained but were smaller, suggesting poorer survival in later years is partly due to demographic characteristics. Relative survival was higher in older patients. Conclusions Changes in patient demographics account for some but not all of the crude survival changes seen during the study period. Relative survival is an under-used methodology in interventional settings like PCI and should be considered wherever survival is compared between populations with different demographic characteristics, such as between countries or time periods.

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Accepted/In Press date: 14 December 2018
e-pub ahead of print date: 9 February 2019
Keywords: coronary intervention, quality in health care

Identifiers

Local EPrints ID: 428324
URI: http://eprints.soton.ac.uk/id/eprint/428324
ISSN: 2044-6055
PURE UUID: 50cd734c-8b68-4186-9992-c743dd436ad1
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 21 Feb 2019 17:30
Last modified: 18 Feb 2021 17:04

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Contributors

Author: William J. Hulme
Author: Matthew Sperrin
Author: Glen Philip Martin
Author: Nick Curzen ORCID iD
Author: Peter Ludman
Author: Evangelos Kontopantelis
Author: Mamas A. Mamas

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