PCV105 A SCOPING REVIEW OF INTERNATIONAL MODELS OF ADULT SPECIALIST CARDIAC NETWORKS

Abstract

Services for cardiac conditions such as acute coronary syndrome (ACS) can be organised into specialist cardiac networks. Although these networks have been shown to improve the quality of care, it is unclear how they are organised in practice. The aim of this scoping review was to identify and describe these models of specialist cardiac networks thereby informing the work of the National Review of Specialist Cardiac Services in Ireland. A scoping review of models of specialist cardiac networks located in EU or high-income countries was undertaken, for the period 01/01/2008 to 13/03/2019. The focus of the scoping review was adult specialist cardiac networks that were hospital-/cardiologist-led, managed and hierarchical. A narrative synthesis was conducted. Eighty-two specialist cardiac networks (ACS-related [n=75]; non ACS-related [n=7]) were identified, located across 21 countries. A key feature of networks was the use of clinical audit to assess performance and inform quality improvement. In the 75 ACS-related networks, ‘hub and spoke’ models featured prominently; at least 55 (73%) ACS networks offered a 24/7 service; the maximum distance between a percutaneous coronary intervention (PCI) centre and a non-PCI centre within a network ranged from 11km to 430km, averaging 113km; and the population served per 24/7 PCI centre ranged from 120,000 to 2.5 million inhabitants, averaging 758,000 inhabitants. In general, increased efficiencies associated with the establishment of the ACS-related networks were reported, both in terms of improvements in time-to-treatment and the proportion of patients receiving primary PCI. There was limited evidence regarding the structure, organisation or efficiencies of networks for non-ACS cardiac conditions. Certain commonalities were found across specialist cardiac networks in particular the use of clinical audit; however, important organisational differences were observed. Efficiencies were noted as a result of the networked provision of care. These findings have implications for the configuration of adult cardiac services.