title: Implementation of NICE clinical guideline 95 on chest pain of recent onset: experience in a district general hospital.
abstract: 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.
authors.affiliation: Wiltshire Cardiac Centre, Swindon, UK.
authors.forename: Julian Om
authors.initials: JO
authors.lastname: Ormerod
authors.affiliation: Wiltshire Cardiac Centre, Swindon, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Wretham
authors.affiliation: Department of Radiology, Great Western Hospital, Swindon, UK.
authors.forename: Andy
authors.initials: A
authors.lastname: Beale
authors.affiliation: Wiltshire Cardiac Centre, Swindon, UK.
authors.forename: Douglas
authors.initials: D
authors.lastname: Haynes
authors.affiliation: Wiltshire Cardiac Centre, Swindon, UK.
authors.forename: Iwan
authors.initials: I
authors.lastname: Harries
authors.affiliation: Wiltshire Cardiac Centre, Swindon, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Ramcharitar
authors.affiliation: Wiltshire Cardiac Centre, Swindon, UK.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Foley
authors.affiliation: Wiltshire Cardiac Centre, Swindon, UK.
authors.forename: William A
authors.initials: WA
authors.lastname: McCrea
authors.affiliation: Wiltshire Cardiac Centre, Swindon, UK.
authors.forename: Badri
authors.initials: B
authors.lastname: Chandrasekaran
authors.affiliation: Wiltshire Cardiac Centre, Swindon, UK edward.barnes@gwh.nhs.uk.
authors.forename: Edward
authors.initials: E
authors.lastname: Barnes
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis*; D003324:Coronary Artery Disease; D025401:Echocardiography, Stress; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006769:Hospitals, General / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
keywords: CG95; NICE; chest pain