Why the study?
The 2016 NICE guidelines updated the management of stable chest pain, replacing pre-test probability scoring with a qualitative approach and recommending non-invasive imaging to reduce invasive angiograms.
Prompts GPs to use CT coronary angiography first for stable chest pain; extends 2010 NICE guidance by eliminating pre-test probability scoring.
In November 2016, the National Institute for Health and Care Excellence (NICE) released an update of its 2010 Clinical Guideline CG95 1 on patients presenting with stable chest pain. 2 This article covers the main changes in the updated CG95, and comments on how GPs can expect the management of patients referred to a cardiology/rapid-access chest pain clinic (RACPC) to change. CHEST PAIN ASSESSMENTAccurate assessment of patients presenting with chest pain is challenging.The combination of a detailed clinical history of the pain, with concomitant risk factors provides the most accurate clinical assessment.3,4 The 2010 guidance used pre-test probability scoring to guide patient investigation and management.The 2016 NICE guidelines do not advocate this and rely on a purely qualitative approach because all those with a clinical suspicion of angina will be investigated the same way.Presenting symptoms are divided into 'typical' and 'atypical'.'Typical' chest pain is classified as including all three of the following features:
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Dancy et al. (2018) conducted a review in Stable angina and chest pain. 64-slice CT coronary angiography (2016 NICE guidelines) vs. 2010 NICE guidelines (pre-test probability scoring) was evaluated. The updated 2016 NICE guidelines recommend 64-slice CT coronary angiography as the first-line investigation for patients with stable chest pain to reduce the reliance on invasive angiograms.
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