Key result
Updated NICE guidelines prioritize CT coronary angiography over functional testing for stable chest pain.
Why the study?
The 2016 NICE guidelines introduced a radical change in diagnosing stable chest pain by shifting from quantitative disease probability assessments to anatomical testing with CTCA or no testing for non-anginal pain.
The 2016 NICE guidelines represent a paradigm shift in stable chest pain investigation, prioritizing anatomical evaluation with CTCA over functional testing and probability scoring.
Simplifies stable chest pain pathways by prioritizing CTCA; leaves open real-world outcome and cost impacts without pre-test probability.
The 2016 National Institute for Health and Care Excellence (NICE) guidelines mark a radical change in the diagnosis of patients with stable chest pain. Quantitative assessments of the disease probability are no longer considered necessary to determine the need and type of diagnostic testing. Instead, the recommendation is for no diagnostic test if the chest pain is judged to be "non-anginal" and CT coronary angiography (CTCA) in patients with "typical" or "atypical" chest pain. The new emphasis on anatomical, rather than functional testing is driven by the accuracy, safety and cost effectiveness of the different investigations as evaluated by NICE. Despite inevitable resource implications NICE calculates that annual savings will be significant.
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Carl A. Roobottom (2018) conducted a review in stable chest pain. 2016 NICE guidelines (CT coronary angiography) vs. Previous guidelines (quantitative assessments of disease probability) was evaluated. The 2016 NICE guidelines recommend CT coronary angiography for typical or atypical stable chest pain, shifting emphasis from functional to anatomical testing.
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