RT Journal Article
SR Electronic
T1 Implementation of NICE clinical guideline 95 on chest pain of recent onset: experience in a district general hospital
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 225
OP 258
DO 10.7861/clinmedicine.15-3-225
VO 15
IS 3
A1 Julian OM Ormerod
A1 Caroline Wretham
A1 Andy Beale
A1 Douglas Haynes
A1 Iwan Harries
A1 Steve Ramcharitar
A1 Paul W Foley
A1 William A McCrea
A1 Badri Chandrasekaran
A1 Edward Barnes
YR 2015
UL http://www.rcpjournals.org/content/15/3/225.abstract
AB The National Institute for Health and Care Excellence (NICE) CG95 clinical guideline on chest pain of recent onset was published in 2010. There is debate over whether the proposed strategy improves patient care and its implications on service costs. Following a six-month pilot, 472 consecutive patient records were audited for pre-test probability of significant coronary artery disease, investigations performed and outcomes. Low- and moderate-risk patients had an unexpectedly low rate of coronary disease and revascularisation. Computerised tomography coronary angiography (CTCA) and stress echocardiography performed similarly, though the latter was more resource intensive. High-/very high-risk patients frequently required revascularisation and greater than 10% of each group had prognostically significant disease, going against the recommendation that very high risk patients do not undergo angiography. There were frequent protocol deviations and training clinic staff in the new approach was challenging. In conclusion, implementing NICE CG95 is feasible but presents challenges. Staff require training to follow the protocol consistently. Functional testing had no benefits over anatomical testing with CTCA, which may allow cost savings in some departments.