Cross-sectional Health Report on Cardiac Surgery - Facilities and Services in Germany

1 Population as of 31st December 1996

2 Morbidity and Mortality 1996
2.1 Morbidity of Ischemic and other Heart Disease by Diagnosis and by Federal State
2.1 Mortality of Ischemic and other Heart Disease by Diagnosis and by Federal State

3.0 Cardiology in 1997
3.1 Cardiologists in Germany - 1996/1997
3.2 Left Heart Catheter Laboratories as of 31 December 1997
3.3 Left Heart Catherterisations and PTCA

4 Cardiac Surgery 1997
4.1 Cardiosurgical Centers
4.2 Cardiosurgeons in Germany as of 31 December 1996
4.3 Open Heart Procedures
4.4 Distribution by Type of Operation
4.5 Minimally Invasive Heart Surgery (MIHS)
4.6 Age Distribution of Cardiosurgical Patients
4.7 Sex Distribution of Cardiosurgical Patients
4.8 Waiting List
4.9 Patient Movement between Federal States
4.10 „Heart Operations" without Heart-Lung Machine
4.11 Expansion of Facilities

5 Pediatric Cardiology and Pediatric Cardiac Surgery
5.1 Pediatric Heart Centers
5.2 Pediatric Cardiology
5.3 Pediatric Cardiac Surgery
5.3.1 Open Heart Surgery in Children
5.3.2 Waiting List

6 Evolution of Facilities and Procedures 1979 to 1997
6.1 Population
6.2 Evolution of Morbidity and Mortality
6.2.1 Morbidity
6.2.2 Mortality by Age, Gender and Federal States
6.3 Evolution of Facilities by Federal States
6.3.1 Left Heart Catheter Laboratories
6.3.2 Cardiosurgical Centers
6.4 Evolution of Diagnostic Interventions
6.5 Evolution of Therapeutic Interventions
6.5.1 PTCA
6.5.2 Open Heart Procedures
6.6 Addition or Substitution
6.7 Outcomes

7 Medical Rehabilitation for Cardiosurgical Patients 1997

8 Quality Assurance in Heart Surgery 1997
8.1 Adult Cardiac Surgery
8.2 Pediatric Cardiology

9 Consequences of New Billing System 1997

10 Comparative Cardiology and Cardiac Surgery in Europe 1996

11 Organ Transplantation 1997
11.1 Transplant Centers
11.2 Heart Transplant Centers
11.3 Kidney Transplant Centers
11.4 Liver Transplant Centers
11.5 Evolution of Organ Transplants since 1992
11.6 The Federal Law on Transplantation (1997)
11.7 Organ Transplantation in Europe



The Tenth German Heart Report analyses the services for patients undergoing Cardiac Surgery in Germany 1997. The first Report on the 'State of Cardiac Surgery in Germany' was drafted after a resolution taken by the 59th Conference of State Health Ministers and Senators at Berlin 17/18th November 1988. The Annual Report has been expanded by the author ever since; the present format covers both Cardiac Surgery and related interventions and data. Still missing is a satisfactory data base relating to cost and expenditure generated by expanding cardiosurgical services.

The 10th German Heart Report contains national and state-level data on
• Morbidity and Mortality of Ischemic and other Heart Diseases by Age and Gender,
• Facilities and Interventions in Cardiology,
• Facilities and Procedures in Cardiosurgery,
• Evolution of Diagnostic and Therapeutic Interventions since 1979 and 1990,
• Medical Rehabilitation of Cardiosurgical Patients,
• the present state of Quality Assurance in Cardiosurgery,
• the impact of the new billing system in cardiac surgery (global payment A and B).
• the European pattern of Facilities and Interventions in Cardiosurgery, and
• Facilities and Procedures in Organ Transplantation.

Analysis of morbidity and mortality of selected heart diseases rests on data readily provided by the Federal Office of Statistics (Statistisches Bundesamt, Wiesbaden).

Data on Adult Cardiology have been collected by State Survey of the Hospital Committee of the Working Group of Federal States' Leading Health Authorities and by the author. Data on pediatric heart catheter laboratories have been provided by the German Society for Pediatric Cardiology.

Data on cardiac surgery were collected in close cooperation with the Society for Thoracic and Cardiovascular Surgery - as agreed in 1989. Processing of basic data was done by the Working Group "Documentation and Quality Assurance in Cardiosurgery at University Hospital Eppendorf (UKE), Hamburg" ("Hamburger Jahresstatistik") and supplemented by the author's own calculations and tabulations to rule out duplicate entries and discrepancies. Results from the Old Federal States (former Federal Territory including West Berlin) and the New Federal States (former German Democratic Republic including East Berlin) have been processed separately again to allow comparison. The European comparison of cardisurgical cover rests on the Report published by Professor Unger of Salzburg, Austria.

Information relating to facilities and workload of heart transplant centers has been extended in this present Heart Report to cover all organ transplantation in Germany 1997. A new transplant law (Transplantationsgesetz) came in toforce in Germany in 1997 which includes regulations on organ procurement and organ distribution. Data on organ transplantation were collected by German Foundation of Organ Transplantation (Deutsche Stiftung Organtransplantation, DSO) and supplemented by the author's own inquiries.

The presentation of Quality Assurance comes from the Office of Bundesarbeitsgemeinschaft Qualitätssicherung Herzchirurgie (Federal Working Party on Quality Assurance in Cardiosurgery) at Ärztekammer Nordrhein (Doctors' Chamber) in Düsseldorf.

My special thanks for generous cooperation in preparing the 10th Heart Report go to the following:
Dipl.Ing. Irrgang, Arbeitsgruppe Dokumentation und Qualitätssicherung in der Herzchirurgie, UKE Hamburg
Professor Dr Polonius, President of the German Society for Thoracic and Cardiovascular Surgery, Dortmund
Professor Dr Hagl, Vice President of the German Society for Thoracic and Cardiovascular Surgery, Heidelberg
Professor Dr Meyer, Pediatric Heart Surgery, Herzzentrum Nordrhein-Westfalen, Bad Oeynhausen
Professor Dr Ulmer, President of the German Society of Pediatric Cardiology, Heidelberg
Professor Dr Held, Chairman of the German Society for Prevention and Rehabilitation in Cardivascular Diseases
Dr Huber, Ärztekammer Nordrhein - Project Office, Quality Assurance in Cardiac Surgery, Düsseldorf
Professor Dr Unger, Salzburg, and
Mr Smit, Deutsche Stiftung Organtransplantation (DSO), Neu-Isenburg

This is the third English Edition.


Facilities and Workload at-a-glance

Population 1996

Germany hat 82,012,162 inhabitants as of 31 December 1996, 39,954,835 men and 42,057,327 women.

Morbidity and Mortality 1996

Analysis includes ICD diagnostic codes 394 to 397, 410, 414, 429 and 745.
Cardiac in-patients total 752,346; men 65 per cent, women 35 per cent.
Deaths total 192,721; men 47 per cent, women 53 per cent.

Cardiology 1997

1,588 cardiologists were on contract as of 31 December 1997.
431 Left heart catheter laboratories were active in 1997.
487,240 left heart catheterisations and 138,001 PTCAs were performed in 1997.

Cardiosurgery 1997

325 heart or thoracic and cardiovascular surgeons active in 1996. 78 cardiosurgical centers active.
92,247 open heart procedures and 37,052 operations without heart-lung machine performed.
67.3 per cent of patients over 60 years old.
Every third open heart procedure done in a patient over 70 years old.
70.1 per cent of open heart procedures performed in men, and 29.1 per cent in women.
Waiting lists totals 7,927 patients.

Pediatric Cardiology and Pediatric Heart Surgery 1997

214 Pediatric heart surgeons active in 1997.
56 Pediatric Heart Centers performed 1,628 open heart porcedures in infants less than 1 year old,
1,752 in children aged one to 10 years and 682 in adolescents aged 10 to under 20 years.

Evolution of Facilities and Workload 1990 - 1997
Mortality rate of acute myocardial infarction declined from 129 in 1990 to 104 in 1997.
Mortality rate of other types of ischemic increased from 60 to 114 since 1990.
Mortality rate of other heart diseases declined from 34 to 17.
Mortality rate of all analysed heart diseases increased from 224 to 235.
The number of left heart catheterisation laboratories increased from 234 to 431.
The number of Cardiosurgical Centers increased from 46 to 78.
The number of left heart catheterisations doubled from 193,673 to 487,240;
the number of PTCAs rose from 33,785 to 138,001.
The number of open heart procedures rose from 38,712 to 92,247.

Medical Rehabilitation 1997

123 in-patient facilities on contract for rehabilitaion in cardiovascular disease.
Cost to Providers (Health Insurance) 1997
A cost estimate for left heart catheterisation, PTCA and early
rehabilitation provided in 1997 totals about DM 4.8 MRD.

European Comparison 1996

Germany ranked first in left heart catheterisations and PTCAs and third in open heart
procedures in European comparison per million population.


Cardiosurgical Centers in Germany 1997 (Location and Medical Directors)
Medical Directors, Cardiosurgery, in Germany in alphabetical order

Leitender Ministerialrat Dr. Ernst Bruckenberger
Hannover, July 1998

English Translation:
Rüdiger A. Hoffmann MD
Frankfurt am Main, December 1998