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Chest pain NICE

Carl Roobottom
The 2016 NICE guidelines mark a radical change in the diagnosis of patients with stable chest pain. Quantitative assessments of the disease probability are no longer considered necessary to determine the need and type of diagnostic testing. Instead, the recommendation is for no diagnostic test if the chest pain is judged to be "non-anginal" and computed tomography coronary angiography (CTCA) in patients with "typical" or "atypical" chest pain. The new emphasis on anatomical, rather than functional testing is driven by the accuracy, safety and cost-effectiveness of the different investigations as evaluated by NICE...
March 7, 2018: British Journal of Radiology
John G Dreisbach, Edward D Nicol, Carl A Roobottom, Simon Padley, Giles Roditi
OBJECTIVE: The National Institute for Health and Care Excellence (NICE) clinical guidelines 'chest pain of recent onset: assessment and diagnosis' (update 2016) state CT coronary angiography (CTCA) should be offered as the first-line investigation for patients with stable chest pain. However, the current provision in the UK is unknown. We aimed to evaluate this and estimate the requirements for full implementation of the guidelines including geographical variation. Ancillary aims included surveying the number of CTCA-capable scanners and accredited practitioners in the UK...
November 14, 2017: Heart: Official Journal of the British Cardiac Society
Abena Y Tannor
BACKGROUND: Low back pain (LBP) has a prevalence of 84% in Africa. The commonest form of imaging is plain lumbar spine x-ray. It gives a radiation dose equivalent to 65 times a chest x-ray dose and sends one of the highest doses to the human reproductive organs. The commonest cause of LBP in Africa is degenerative disease. X-ray findings do not change mode of treatment yet most physicians still routinely request for x-rays. METHODS: This is a systematic review of databases including The Cochrane, CINAHL plus, AMED, and MEDLINE...
March 2017: Ghana Medical Journal
Edward Watts Carlton, John William Pickering, Jaimi Greenslade, Louise Cullen, Martin Than, Jason Kendall, Richard Body, William A Parsonage, Ahmed Khattab, Kim Greaves
OBJECTIVE: We aimed to evaluate the limit of detection of high-sensitivity troponin (hs-cTn) and Thrombolysis In Myocardial Infarction (TIMI) score combination rule-out strategy suggested within the 2016 National Institute for Health and Care Excellence (NICE) Chest Pain of Recent Onset guidelines and establish the optimal TIMI score threshold for clinical use. METHODS: A pooled analysis of adult patients presenting to the emergency department with chest pain and a non-ischaemic ECG, recruited into six prospective studies, from Australia, New Zealand and the UK...
September 1, 2017: Heart: Official Journal of the British Cardiac Society
Philip D Adamson, Amanda Hunter, Michelle C Williams, Anoop S V Shah, David A McAllister, Tania A Pawade, Marc R Dweck, Nicholas L Mills, Colin Berry, Nicholas A Boon, Elizabeth Clark, Marcus Flather, John Forbes, Scott McLean, Giles Roditi, Edwin J R van Beek, Adam D Timmis, David E Newby
OBJECTIVES: To evaluate the diagnostic and prognostic benefits of CT coronary angiography (CTCA) using the 2016 National Institute for Health and Care Excellence (NICE) guidelines for the assessment of suspected stable angina. METHODS: Post hoc analysis of the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial of 4146 participants with suspected angina randomised to CTCA. Patients were dichotomised into NICE guideline-defined possible angina and non-anginal presentations...
February 2018: Heart: Official Journal of the British Cardiac Society
Alexandros Papachristidis, Daniela Cassar Demarco, Damian Roper, Ioannis Tsironis, Michael Papitsas, Jonathan Byrne, Khaled Alfakih, Mark J Monaghan
OBJECTIVE: In this study, we assess the clinical and cost-effectiveness of stress echocardiography (SE), as well as the place of SE in patients with high pretest probability (PTP) of coronary artery disease (CAD). METHODS: We investigated 257 patients with no history of CAD, who underwent SE, and they had a PTP risk score >61% (high PTP). According to the National Institute for Health and Care Excellence guidance (NICE CG95, 2010), these patients should be investigated directly with an invasive coronary angiogram (ICA)...
2017: Open Heart
Khaled Alfakih, John P Greenwood, Sven Plein
The National Institute for Health and Care Excellence (NICE) published an update on its guideline on chest pain of recent onset in 2016. The new guideline makes three key changes to the 2010 version. NICE recommend that the previously proposed pre-test probability risk score should no longer be used. They also recommend that a calcium score of zero should no longer be used to rule out coronary artery disease in patients with low pre-test probability. However, the most radical change is that NICE now recommend that all patients with new onset chest pain should be investigated with a computerised tomography coronary angiogram as a first-ine investigation...
June 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
Alastair J Moss, Michelle C Williams, David E Newby, Edward D Nicol
PURPOSE OF REVIEW: Cost-effective care pathways are integral to delivering sustainable healthcare programmes. Due to the overestimation of coronary artery disease using traditional risk tables, non-invasive testing has been utilised to improve risk stratification and initiate appropriate management to reduce the dependence on invasive investigations. In line with recent technological improvements, cardiac CT is a modality that offers a detailed anatomical assessment of coronary artery disease comparable to invasive coronary angiography...
2017: Current Cardiovascular Imaging Reports
Adam Timmis, Carl A Roobottom
In the 2016 update of the stable chest pain guideline, the National Institute for Health and Care Excellence (NICE) has made radical changes to the diagnostic paradigm that it-like other international guidelines-had previously placed at the centre of its recommendations. No longer are quantitative assessments of the disease probability considered necessary to determine the need for diagnostic testing and the choice of test. Instead, the recommendation is for no diagnostic testing if chest pain is judged to be 'non-anginal' and CT coronary angiography (CTCA) in patients with 'typical' or 'atypical' chest pain with additional perfusion imaging only if there is uncertainty about the functional significance of coronary lesions...
July 2017: Heart: Official Journal of the British Cardiac Society
Irene Bighelli, Carlotta Trespidi, Mariasole Castellazzi, Andrea Cipriani, Toshi A Furukawa, Francesca Girlanda, Giuseppe Guaiana, Markus Koesters, Corrado Barbui
BACKGROUND: A panic attack is a discrete period of fear or anxiety that has a rapid onset, reaches a peak within 10 minutes and in which at least four of 13 characteristic symptoms are experienced, including racing heart, chest pain, sweating, shaking, dizziness, flushing, stomach churning, faintness and breathlessness. Panic disorder is common in the general population with a lifetime prevalence of 1% to 4%. The treatment of panic disorder includes psychological and pharmacological interventions...
September 12, 2016: Cochrane Database of Systematic Reviews
Ingrid Torjesen
No abstract text is available yet for this article.
July 12, 2016: BMJ: British Medical Journal
Arzu Cubukcu, Ian Murray, Simon Anderson
In 2010, the National Institute for Heath and Clinical Excellence published guidelines for the management of stable chest pain of recent onset. Implementation has occurred to various degrees throughout the NHS; however, its effectiveness has yet to be proved. A retrospective study was undertaken to assess the impact and relevance of this guideline, comparing the estimated risk of coronary artery disease (CAD) with angiographic outcomes. Findings were compared with the recently published equivalent European guideline...
June 1, 2015: Echo Research and Practice
Daniela Cassar Demarco, Alexandros Papachristidis, Damian Roper, Ioannis Tsironis, Jonathan Byrne, Khaled Alfakih, Mark Monaghan
OBJECTIVES: To compare how patients with chest pain would be investigated, based on the two guidelines available for UK cardiologists, on the management of patients with stable chest pain. The UK National Institute of Clinical Excellence (NICE) guideline which was published in 2010 and the European society of cardiology (ESC) guideline published in 2013. Both guidelines utilise pre-test probability risk scores, to guide the choice of investigation. DESIGN: We undertook a large retrospective study to investigate the outcomes of stress echocardiography...
November 2015: JRSM Open
Ozan M Demir, Peter Dobson, Nikolaos D Papamichael, Jonathan Byrne, Sven Plein, Khaled Alfakih
The European Society of Cardiology (ESC) and UK National Institute for Health and Care Excellence (NICE) have recently published guidelines for investigating patients with suspected coronary artery disease (CAD). Both provide a risk score (RS) to assess the pre-test probability for CAD to guide clinicians to undertake the most effective investigation. The aim of the study was to establish whether there is a difference between the two RS models. We retrospectively reviewed records of 479 patients who presented to a UK district general hospital with chest pain between August 2011 and April 2013...
June 2015: Clinical Medicine: Journal of the Royal College of Physicians of London
Julian Om Ormerod, Caroline Wretham, Andy Beale, Douglas Haynes, Iwan Harries, Steve Ramcharitar, Paul W Foley, William A McCrea, Badri Chandrasekaran, Edward Barnes
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...
June 2015: Clinical Medicine: Journal of the Royal College of Physicians of London
Alvin J X Lee, Michael Michail, Shumonta A Quaderi, James A Richardson, Suneil K Aggarwal, M Elsya Speechly-Dick
OBJECTIVE: In 2010, the National Institute for Health and Care Excellence (NICE) in the UK published Clinical Guideline 95 (CG95) advocating risk stratification of patients using 'CADScore' to guide appropriate cardiac investigations for chest pain of recent onset. Implementation of the guideline in the University College London Hospitals NHS Foundation Trust was evaluated to see if it led to a reduction in the average cost of the diagnostic journey per patient and fewer investigations per patient in order to confirm a diagnosis...
2015: Open Heart
Ronak Rajani, Jessica Webb, Anna Marciniak, Rebecca Preston
BACKGROUND: To evaluate diagnostic strategies in a rapid access chest pain clinic (RACPC) in the United Kingdom and to predict the economical and clinical impacts of incorporating fractional flow reserve by coronary computed tomographic angiography (FFRCT) into future pathways. METHODS: A retrospective analysis of consecutive patients referred to a RACPC in the United Kingdom. All patients had an evaluation of cardiovascular risk factors and symptoms from which the pre-test likelihood (PTL) of coronary artery disease (CAD) was evaluated using the Diamond Forrester (DF) criteria...
March 15, 2015: International Journal of Cardiology
Mohammed Aldwaik, Aled P Williams, Simon Le Feuvre, Richard Cowell
Chest pain (CP) is a very common presentation with a wide range of differential diagnoses, including life-threatening conditions, which need to be considered, diagnosed and treated urgently. Cardiac CP accounts for less than one-third of causes. Echocardiography is a valuable non-invasive tool that can help in diagnosing and treating patients presenting with CP. National Institute for Health and Care Excellence (NICE), European Society of Cardiology (ESC) and American Heart Association (AHA) guidelines state that echocardiography can help in the diagnosis of acute coronary syndromes and also in ruling out other serious conditions...
December 8, 2014: BMJ Case Reports
Caroline Marie Patterson, Arjun Nair, Nabeel Ahmed, Leoni Bryan, Derek Bell, Edward David Nicol
OBJECTIVE: To describe the clinical outcomes of patients for whom National Institute for Health and Care Excellence (NICE) recent-onset chest pain guidance would not have recommended further investigation, compared with those of patients where further investigation would have been recommended. METHODS: 557 consecutive patients with recent-onset chest pain attending rapid-access chest pain clinics (RACPC) in two district general hospitals over a 9-month period were retrospectively reviewed...
January 2015: Heart: Official Journal of the British Cardiac Society
Christopher W Pavitt, Katie Harron, Alistair C Lindsay, Robin Ray, Sayeh Zielke, Daniel Gordon, Michael B Rubens, Simon P Padley, Edward D Nicol
We validate a method of calcium scoring on CT coronary angiography (CTCA) and propose an algorithm for the assessment of patients with stable chest pain. 503 consecutive patients undergoing coronary artery calcium score (CACS) and CTCA were included. A 0.1 cm2 region of interest was used to determine the mean contrast density on CTCA images either in the left main stem (LM) or right coronary artery. Axial 3 mm CTCA images were scored for calcium using conventional software with a modified threshold: mean LM contrast density (HU) + 2SD...
August 2014: International Journal of Cardiovascular Imaging
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