56 Survey of cardiologists opinion on the nice 2016 guideline on the investigation of stable chest pain

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Abstract

Introduction

NICE updated its guideline on stable chest pain in 2016. They recommended that the pre-test probability (PTP) risk score should not be used and that CT coronary angiography (CTCA) should be the first line investigation for all patients. The opinion and adherence to these guidelines amongst UK Cardiologists is unknown.

Methods

A short questionnaire was designed using electronic survey software and e-mailed to UK consultant cardiologists via a cardiology consultant directory.

Results

A total of 887 cardiologists were emailed; 257 opened the email and 162 (63%) responded. The respondents were a representative sample of UK cardiologists.

Results

More than 61% of respondents did not agree with the removal of the PTP risk score. Whilst 71% felt CTCA was the optimal modality to investigate patients with low-intermediate PTP chest pain, just 37% felt it was the best test for intermediate-high PTP chest pain patients.

Results

For patients with CTCA finding of 50%–70% stenosis (excluding LMS), 49% of cardiologists would investigate further with a functional imaging test while 38% would undertake invasive coronary angiography ±fractional flow reserve (FFR), 2% would use CT-FFR and 11% opted for medical management.

Results

In context of a CTCA finding of greater than 70% stenosis (excluding LMS), 81% would investigate with invasive angiography ±FFR, with 15% choosing functional testing, 0.7% would use CT-FFR and 4% would manage medically.

Results

Only 26% of respondents felt NICE 2016 guidelines most closely mirrored their clinical practice, 41% utilised the ESC guidelines, 22% adhered to neither ESC nor NICE guidelines and 11% still use exercise ECG as first line test.

Conclusion

UK cardiologists are using both ESC and NICE guidelines as sources of recommendations. 67% of UK cardiologists prefer functional imaging tests for the investigation of patients with intermediate-high PTP, while the majority (71%) have accepted that CTCA is the best test in patients with low-intermediate PTP.

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