Assessment of recent onset chest pain or discomfort of suspected cardiac origin: summary of NICE guidance

Chest pain is very common, and in the United Kingdom about 1% of visits to a general practitioner, 5% of visits to the emergency department, and 25% of emergency hospital admissions are for this symptom.1 Chest pain has many causes, and when the cause could be cardiac in origin, appropriate and timely assessment and diagnostic investigation are needed. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin.2 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the experience and opinion of the Guideline Development Group (GDG) on what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. Two separate diagnostic pathways are presented. The first is for people with acute chest pain in whom an acute coronary syndrome is suspected. The second is for people with intermittent stable chest pain in whom stable angina is suspected. ### Acute chest pain and suspected acute coronary syndrome #### Initial clinical assessment and referral to hospital