NICE guidelines for new chest pain: comparison of new and old services

In 2000 the National Service Framework for Coronary Artery Disease (CAD) prompted the development of rapid-access chest pain clinics (RACPCs). The aim of such clinics is to provide prompt assessment of chest pain to identify CAD with the use of an exercise tolerance test. In 2010, the National Institute for Health and Clinical Excellence (NICE) guidelines recommended using imaging studies based on CAD risk scoring and not an exercise tolerance test to exclude angina in patients with no previous history of known CAD. A comparison of the use of the 2010 NICE guidelines for the management of new-onset chest pain within a well-established exercise-based RACPC service is undocumented. The new recommendation moves the focus towards discharging low-risk patients, imaging studies/invasive procedure (angiogram) for the moderate-risk group and initiating anti-anginal treatment for the high-risk group. To phase the new recommendations into clinical practice in a district general hospital, the new guidelines were implemented in one out of three RACPC sessions per week. A retrospective assessment was carried out over a 4-month period to evaluate the new service implementation. A total of 160 patients attended the RACPC service, of which 56 (35%) were offered treatments according to the newer NICE guidelines and 104 (65%) were managed with the aim of exercising on the treadmill. This review gives an insight into the benefits of the new recommendations in practice, as well as highlighting some of the immediate limitations and barriers encountered.