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Cardiac interventions in Wales: A comparison of benefits between NHS Wales specialties

Gareth Davies Orcid Logo, Ashley Akbari Orcid Logo, Rowena Bailey, Lloyd Evans, Kendal Smith, Jonathan Goodfellow, Michael Thomas, Kerryn Lutchman Singh

PLOS ONE, Volume: 19, Issue: 2

Swansea University Authors: Gareth Davies Orcid Logo, Ashley Akbari Orcid Logo, Rowena Bailey

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DOI (Published version): 10.1371/journal.pone.0297049

Abstract

ObjectivesThe study aimed to assess if specialised healthcare service interventions in Wales benefit the population equitably in work commissioned by the Welsh Health Specialised Services Committee (WHSSC).ApproachThe study utilised anonymised individual-level, population-scale, routinely collected...

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Published in: PLOS ONE
ISSN: 1932-6203
Published: Public Library of Science (PLoS) 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa65627
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Measurement was undertaken of associated patient outcomes 2-years before and after the intervention (minus a 6-month clearance period on either side) by measuring events in primary care, hospital attendance, outpatient and emergency department. The analysis controlled for comorbidity (Charlson) and deprivation (Welsh Index of Multiple Deprivation), stratified by admission type (elective or emergency) and membership of top 5% post-intervention costs. Costs were estimated by multiplying events by mean person cost estimates.ResultsWe identified 5,999 percutaneous coronary interventions (PCI) and 1,640 coronary artery bypass graft (CABG) between 2014-06-01 to 2020-02-29. The ratio of emergency to elective interventions was 2.85 for PCI and 1.04 for CABG. In multivariate analysis significant associations were identified for comorbidity (OR = 1.52, CI = (1.01&#x2013;2.27)), deprivation (OR = 1.34, CI = (1.03&#x2013;1.76)) and rurality (OR = 0.81, CI = (0.70&#x2013;0.95)) for PCI interventions, and comorbidity (OR = 1.47, CI = (1.10&#x2013;1.98)) for CABG. Higher costs post-intervention were associated with increased comorbidity for PCI and CABG in the top 5% cost groups, but for PCI this was not seen outside the top 5%. For PCI, moderate cost increase was associated with increased deprivation, but the picture was more mixed following CABG interventions. 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spelling 2024-04-04T12:04:07.9149110 v2 65627 2024-02-11 Cardiac interventions in Wales: A comparison of benefits between NHS Wales specialties 98490239b86cc892a382416d048cdb3c 0000-0001-9005-1618 Gareth Davies Gareth Davies true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 455e2c1e6193448f6269b9e72acaf865 Rowena Bailey Rowena Bailey true false 2024-02-11 MEDS ObjectivesThe study aimed to assess if specialised healthcare service interventions in Wales benefit the population equitably in work commissioned by the Welsh Health Specialised Services Committee (WHSSC).ApproachThe study utilised anonymised individual-level, population-scale, routinely collected electronic health record (EHR) data held in the Secure Anonymised Information Linkage (SAIL) Databank to identify patients resident in Wales receiving specialist cardiac interventions. Measurement was undertaken of associated patient outcomes 2-years before and after the intervention (minus a 6-month clearance period on either side) by measuring events in primary care, hospital attendance, outpatient and emergency department. The analysis controlled for comorbidity (Charlson) and deprivation (Welsh Index of Multiple Deprivation), stratified by admission type (elective or emergency) and membership of top 5% post-intervention costs. Costs were estimated by multiplying events by mean person cost estimates.ResultsWe identified 5,999 percutaneous coronary interventions (PCI) and 1,640 coronary artery bypass graft (CABG) between 2014-06-01 to 2020-02-29. The ratio of emergency to elective interventions was 2.85 for PCI and 1.04 for CABG. In multivariate analysis significant associations were identified for comorbidity (OR = 1.52, CI = (1.01–2.27)), deprivation (OR = 1.34, CI = (1.03–1.76)) and rurality (OR = 0.81, CI = (0.70–0.95)) for PCI interventions, and comorbidity (OR = 1.47, CI = (1.10–1.98)) for CABG. Higher costs post-intervention were associated with increased comorbidity for PCI and CABG in the top 5% cost groups, but for PCI this was not seen outside the top 5%. For PCI, moderate cost increase was associated with increased deprivation, but the picture was more mixed following CABG interventions. For both interventions, lower costs post intervention were seen in rural locations.ConclusionWe identified and compared health outcomes for selected specialist cardiac interventions amongst patients resident in Wales, with these methods and analyses, providing a template for comparing other cardiac interventions. Journal Article PLOS ONE 19 2 Public Library of Science (PLoS) 1932-6203 9 2 2024 2024-02-09 10.1371/journal.pone.0297049 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University The work was funded by the Welsh Health Specialised Services Committee (WHSSC). 2024-04-04T12:04:07.9149110 2024-02-11T12:48:54.4203267 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Gareth Davies 0000-0001-9005-1618 1 Ashley Akbari 0000-0003-0814-0801 2 Rowena Bailey 3 Lloyd Evans 4 Kendal Smith 5 Jonathan Goodfellow 6 Michael Thomas 7 Kerryn Lutchman Singh 8 65627__29635__00cf30a3368e4710a99a32f0beedac3f.pdf 65627.pdf 2024-03-05T10:37:52.9332371 Output 2295579 application/pdf Version of Record true © 2024 Davies et al. This is an open access article distributed under the terms of the Creative Commons Attribution License. true eng https://creativecommons.org/licenses/by/4.0/
title Cardiac interventions in Wales: A comparison of benefits between NHS Wales specialties
spellingShingle Cardiac interventions in Wales: A comparison of benefits between NHS Wales specialties
Gareth Davies
Ashley Akbari
Rowena Bailey
title_short Cardiac interventions in Wales: A comparison of benefits between NHS Wales specialties
title_full Cardiac interventions in Wales: A comparison of benefits between NHS Wales specialties
title_fullStr Cardiac interventions in Wales: A comparison of benefits between NHS Wales specialties
title_full_unstemmed Cardiac interventions in Wales: A comparison of benefits between NHS Wales specialties
title_sort Cardiac interventions in Wales: A comparison of benefits between NHS Wales specialties
author_id_str_mv 98490239b86cc892a382416d048cdb3c
aa1b025ec0243f708bb5eb0a93d6fb52
455e2c1e6193448f6269b9e72acaf865
author_id_fullname_str_mv 98490239b86cc892a382416d048cdb3c_***_Gareth Davies
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
455e2c1e6193448f6269b9e72acaf865_***_Rowena Bailey
author Gareth Davies
Ashley Akbari
Rowena Bailey
author2 Gareth Davies
Ashley Akbari
Rowena Bailey
Lloyd Evans
Kendal Smith
Jonathan Goodfellow
Michael Thomas
Kerryn Lutchman Singh
format Journal article
container_title PLOS ONE
container_volume 19
container_issue 2
publishDate 2024
institution Swansea University
issn 1932-6203
doi_str_mv 10.1371/journal.pone.0297049
publisher Public Library of Science (PLoS)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description ObjectivesThe study aimed to assess if specialised healthcare service interventions in Wales benefit the population equitably in work commissioned by the Welsh Health Specialised Services Committee (WHSSC).ApproachThe study utilised anonymised individual-level, population-scale, routinely collected electronic health record (EHR) data held in the Secure Anonymised Information Linkage (SAIL) Databank to identify patients resident in Wales receiving specialist cardiac interventions. Measurement was undertaken of associated patient outcomes 2-years before and after the intervention (minus a 6-month clearance period on either side) by measuring events in primary care, hospital attendance, outpatient and emergency department. The analysis controlled for comorbidity (Charlson) and deprivation (Welsh Index of Multiple Deprivation), stratified by admission type (elective or emergency) and membership of top 5% post-intervention costs. Costs were estimated by multiplying events by mean person cost estimates.ResultsWe identified 5,999 percutaneous coronary interventions (PCI) and 1,640 coronary artery bypass graft (CABG) between 2014-06-01 to 2020-02-29. The ratio of emergency to elective interventions was 2.85 for PCI and 1.04 for CABG. In multivariate analysis significant associations were identified for comorbidity (OR = 1.52, CI = (1.01–2.27)), deprivation (OR = 1.34, CI = (1.03–1.76)) and rurality (OR = 0.81, CI = (0.70–0.95)) for PCI interventions, and comorbidity (OR = 1.47, CI = (1.10–1.98)) for CABG. Higher costs post-intervention were associated with increased comorbidity for PCI and CABG in the top 5% cost groups, but for PCI this was not seen outside the top 5%. For PCI, moderate cost increase was associated with increased deprivation, but the picture was more mixed following CABG interventions. For both interventions, lower costs post intervention were seen in rural locations.ConclusionWe identified and compared health outcomes for selected specialist cardiac interventions amongst patients resident in Wales, with these methods and analyses, providing a template for comparing other cardiac interventions.
published_date 2024-02-09T08:28:09Z
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