TY - JOUR 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 SP - 225 LP - 258 DO - 10.7861/clinmedicine.15-3-225 VL - 15 IS - 3 AU - Julian OM Ormerod AU - Caroline Wretham AU - Andy Beale AU - Douglas Haynes AU - Iwan Harries AU - Steve Ramcharitar AU - Paul W Foley AU - William A McCrea AU - Badri Chandrasekaran AU - Edward Barnes Y1 - 2015/06/01 UR - http://www.rcpjournals.org/content/15/3/225.abstract N2 - 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. ER -