The consequences of applying NICE chest pain guidelines to an acute medical population: a role for cardiac computed tomography

Abstract

Applying current NICE guidelines for chest pain of recent onset to medical admissions results in a lesser uptake of CCT than functional testing and invasive angiography. If the NICE guidelines are revised to include patients with an intermediate pre-test probability of CAD, CCT may have a greater role.

Clinical outcomes when applying NICE guidance for the investigation of recent-onset chest pain to a rapid-access chest pain clinic population

“…NICE guidelines currently recommend CT calcium scoring when in patients with a low (10%–29%) likelihood of CAD. There is emerging evidence that extending CT calcium scoring to patients with low and intermediate pretest probability of CAD, in addition to (but not in place of) clinical assessment could also improve CAD prediction 8 25 26. The availability of this test to RACPC clinicians, although increasing, is still variable.…”

“…Methods for gathering the required clinical information, and for defining angina (as proposed by Diamond6 and adopted by NICE3) have previously been described 7 8. The research protocol received approval to proceed from the Institutional R&D Office.…”

Impact of applying NICE guidance for the assessment of stable chest pain in rapid access chest pain clinics in a DGH: A service evaluation

“…Capital investment would potentially be needed to implement CG95. There is little data on the proportion of RACPC referrals that will need these imaging modalities [2][3][4]. We instituted a prospective audit of RACPC referrals to estimate the impact of CG95 on the service requirements in a DGH.…”

“…2). The differences in these characteristics between published study cohorts [2][3][4] and the general population need consideration when extrapolating these results to other UK patients. Prevalence of TyCP, ATypCP and NACP is comparable to previous studies [2,[5][6][7][8][9].…”

“…Transient loss of consciousness (TLOC) is prevalent among young adults and frequently has a benign prognosis. However, when associated with certain clinical profiles it may herald serious cardiac disease [1][2][3][4][5][6]. Despite this, routine assessment through questionnaires has only been routinely performed during pre-participation screening of young athletes [7][8][9].…”