Implementation of a modified version of NICE CG95 on chest pain of recent onset: Experience in a DGH
Green P., Jordan S., Ormerod JOM., Haynes D., Harries I., Ramcharitar S., Foley P., McCrea W., Beale A., Chandrasekaran B., Barnes E.
National Institute for Health and Care Excellence (NICE) clinical guideline 95 (CG95) was introduced to rapidaccess chest pain clinics (RACPC) to aid investigation of possible stable angina based on pretest probability of coronary artery disease (CAD). Following a six-month audit of its implementation we introduced a modified version: patients with low/ moderate risk of CAD were referred for computed tomography coronary angiography (CTCA), while those at high/ very high risk were referred for invasive angiography. Patient records of 546 patients referred to our RACPC over a six-month period were retrospectively analysed. Pretest probability of CAD, referral for initial investigation, and outcomes at a minimum follow-up time of six months were documented. Incidence of CAD correlated well with pretest probability. Moderaterisk patients had a low incidence of CAD and revascularisation. High/ very high-risk patients had a high incidence of revascularisation, and this was predominantly for prognostically significant disease. In conclusion, low rates of CAD in lowand moderate-risk groups justifies the use of CTCA as a first-line investigation in these patients. Routine investigation of very high-risk patients allows a high proportion to undergo revascularisation for prognostically significant disease. Strict adherence to NICE CG95 could lead to these patients being missed.