Abstract 15649: Non-invasive Investigations For Chest Pain: The Impact Of National Guidance On Service Provision And Patient Outcome In A District General Hospital
OBJECTIVE: To examine the impact of implementing the 2010 National Institute for Health and Clinical Excellence (NICE) guidelines for the assessment of recent onset chest pain on local cardiac services and patient outcomes in a non-national health service (NHS), British district general hospital.
DESIGN: Retrospective cohort study of patients referred to secondary care for assessment of new onset chest pain.
SETTING: Jersey General Hospital Cardiology department, Channel Islands
PARTICIPANTS: 81 patients referred for exercise tolerance test for assessment of new onset chest pain between 1st September and 30th November 2009.
MAIN OUTCOME MEASURES: Number of investigations requested for investigation of coronary artery disease and incidence of adverse cardiac events at one year, following exercise tolerance test. Retrospective calculation of the number of investigations for new onset chest pain as recommended by NICE guidelines, with examination of potential to improve outcomes and the associated costs.
RESULTS: No deaths or adverse events, attributable to coronary artery disease, were recorded in study patients at one-year post exercise tolerance test. 14 patients were excluded from further analysis due to incomplete records. Of the remaining 67 patients, had they been investigated as per the national guidelines, 8 CT calcium scores, 18 non-invasive functional imaging and 12 coronary angiograms would have been performed as first line investigation instead of 67 exercise tolerance tests. Introduction of the NICE guidance in study patients would have been more than twice as expensive, increasing costs by a factor of 2.3 versus current practice, without improving outcomes at one year.
CONCLUSIONS: At one year, there is no improvement in terms of outcomes for patients by introduction of the 2010 NICE guidelines. The cost and service provision needed to introduce these guidelines for an isolated district general hospital would be significant, with no apparent benefit. Larger studies, with a longer follow up are needed to support these findings.
- © 2011 by American Heart Association, Inc.