Assessing the implications of implementing the NICE guideline 95 for evaluation of stable chest pain of recent onset: a single centre experience

Abstract

If the NICE guidance on chest pain of recent onset had been implemented in our study population, the need for change of the offer of specific first line tests (as discussed above) means that, a major re-organisation in both the services in RACPCs and the current process of referral to these specialists cardiac services from the primary care physicians will be required. Whilst acknowledging that regional variations may exist in the proportions of tests needed (depending on the incidence and prevalence of CAD and risk factors), these figures from our study represent a much higher level of need of these specialist tests for patients attending RACPCs than initially suggested by contemporary reviews. We therefore conclude that data from larger studies in many regions may be useful for understanding the degree of regional and national changes required for organising the structure and referrals to specialist cardiac services in Scotland, if an equitable service based on NICE guidance 95 is rolled out throughout United Kingdom in future.

Triaging Primary Care Patients Referred for Chest Pain to Specialist Cardiology Centres: Efficacy of an Optimised Protocol

“…The algorithm of RACPCs under NICE 95 Guidelines is as follows: Very low-risk patients are reassured and discharged; low-risk patients are offered cardiac computed tomography (CT); intermediate-risk patients are offered functional imaging; and high-risk patients are offered invasive coronary angiography or functional testing. [15][16][17] With over160 clinics rolled out in the UK and adoption in Australia, 18,19 reviews on RACPCs have been mixed. The system uses evidencebased medicine to shorten diagnosis times 20 and provides patients with faster reassurance, 21 but in some studies, it has increased investigation costs and hence, overall costs.…”

“…It yielded results comparable to the original Duke Clinical Score. 12,13 Patients were stratified into 3 risk cohorts according to the MCDS score: low (<10), intermediate (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) and high (>20); and compared between triages and controls. A sensitivity analysis was performed using the CAD Consortium Risk Score 14 (CRS)-a published European cardiovascular risk score not validated locally-…”

Advanced interventional cardiac procedures and perioperative care required to prevent the epidemic of end-stage heart disease in Sri Lanka

“…The active search for ischemic heart disease, is still poorly performed, based predominantly on tests such as exercise stress test, which has a poor sensitivity and specificity and has been deemed unreliable and superseded by better diagnostic tests in many other countries 3 . Operator-dependent advanced imaging modalities to detect rare structural or congenital disease, for instance anomalous vessels causing shunts 4 or morphologically abnormal valves, failing prosthetic valves with conflicting haemodynamic data or concomitant coronary disease is often poorly investigated or managed with new insights late to be implemented 5 .…”