Clinical history versus the exercise ECG in assessment of stable coronary artery disease

Reports highlighting the benefits of ‘nurse-led’ services invariably emphasize the importance of education and training. There is however a dearth of literature describing the training in or quality of clinical history-taking among cardiovascular nurses. Recent publications and forthcoming national guidance will re-emphasize the importance of clinical history-taking, and that the diagnosis of angina pectoris can be made solely on the basis of the presenting patient history. Furthermore, evolving guidance will discourage clinicians from using the exercise ECG as the primary diagnostic test for myocardial ischaemia. This will result in a significant shift in practice in the majority of centres across the United Kingdom, many of whom have chest pain assessment services led by cardiovascular nurses. If cardiovascular nurses are to claim the contemporaneous role of ‘clinician’, critical appraisal and preparation for these shifts in practice will be crucial.