Key result
Applying NICE guidance for stable chest pain indicated 30% would require functional imaging and 22% cardiac CT, compared to 52% requiring exercise testing under previous practice.
Why the study?
How does the application of NICE 2010 guidelines affect the service requirement for non-invasive cardiac imaging in patients with stable chest pain compared to previous practice?
Observational (n=500)
No
How does the application of NICE 2010 guidelines affect the service requirement for non-invasive cardiac imaging in patients with stable chest pain compared to previous practice?
Application of the 2010 NICE guidelines for stable chest pain indicates that functional imaging and cardiac CT are the dominant required investigations, shifting away from exercise tolerance testing.
May shift service demand toward CT and functional imaging; leaves open real-world impact on accuracy and outcomes.
Objective: Chest pain or discomfort due to angina could have a potentially poor prognosis, emphasising the importance of prompt and accurate diagnosis. National Institute of Clinical Excellence (NICE) of UK has published a E Chest pain of recent onseta ETM guidelines in March 2010. These guidelines appraise the role of latest non-invasive modalities in cardiac imaging to promptly and cost-effectively diagnose coronary artery disease. We aimed to study the service requirement for non-invasive cardiac imaging in patients with stable chest pain using this guidance. Method: Design: Single centre, six months (January 2010 to June 2010) observational study. Setting: Rapid Access Chest Pain Clinics (RACPC) in a large UK based University Teaching Hospital providing secondary care Cardiology services. Clinic letters were used to ascertain the type of chest pain and cardiovascular risk factors. The resting 12 lead electrocardiogram (ECG) was examined for any ischemic changes. Patients were then retrospectively allocated to an assessment pathway based on NICE guidance for the evaluation of stable chest pain. Pre-test likelihood of Coronary artery disease (CAD) was calculated using Pryor et ala ETM s table as published by NICE. Depending on the calculated pre-test probability, their NICE suggested investigation was determined. This included -no further investigations, cardiac computed tomography (CT), functional imaging or invasive angiography Result: 500 patients were seen in RACPC, out of which, 65 patients did not meet the referral criteria of having chest pain. 52% of patients were likely to have Exercise Tolerance Test (ETT) based on previous practice. According to current NICE guidance as applied to our cohort of patients, 128 (30%) would have required functional imaging, 119 (27%) no further investigation, 95 (22%), cardiac CT and 93 (21%) invasive angiography respectively. Conclusion: Functional imaging and then cardiac CT are the dominant investigations which would be required in the assessment of stable chest pain patients.
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Garg et al. (2012) conducted an observational in Stable chest pain (n=500). NICE guidance for stable chest pain vs. Previous practice was evaluated on Suggested investigation based on calculated pre-test probability of coronary artery disease. Applying NICE guidance for stable chest pain indicated 30% would require functional imaging and 22% cardiac CT, compared to 52% requiring exercise testing under previous practice.
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