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Challenges in delivering computed tomography coronary angiography as the first-line test for stable chest pain
John G Dreisbach1, Edward D Nicol2, Carl A Roobottom3
1Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK.
Insights
Current UK provision for CT coronary angiography (CTCA) is insufficient to meet NICE guidelines for stable chest pain. An estimated 350,000 CTCA scans are needed, but only 42,340 are performed annually, highlighting a significant gap in service provision.
Area of Science:
- Cardiology
- Medical Imaging
- Health Services Research
Background:
- NICE guidelines recommend CT coronary angiography (CTCA) as first-line for stable chest pain.
- Current UK provision and capacity for CTCA are not well-established.
- Understanding current service provision is crucial for guideline implementation.
Purpose of the Study:
- To evaluate current CT coronary angiography (CTCA) provision in the UK.
- To estimate the requirements for full implementation of NICE guidelines.
- To assess geographical variations and identify resource needs (scanners, practitioners).
Main Methods:
- Surveyed annual CTCA scan numbers across the NHS.
- Modeled CTCA requirements based on SCOT-HEART data and 2015 percutaneous coronary interventions for stable angina.
- Collected data on CTCA-capable scanners and accredited practitioners.
Main Results:
- Approximately 42,340 CTCA scans are performed annually in the UK.
- An estimated 350,000 CTCA scans are required for full guideline implementation.
- 304 CTCA-capable scanners and 198 accredited practitioners were identified, with significant geographical variation.
Conclusions:
- Significant increase in CTCA provision is needed to align with NICE guidelines.
- Limited specialist workforce and scanner availability pose challenges to service expansion.
- Addressing geographical disparities is essential for equitable implementation.
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.
Methods:
The number of CTCA scans performed annually was surveyed across the National Health Service (NHS). The number of percutaneous coronary interventions performed for stable angina in the NHS in 2015 was applied to a model based on SCOT-HEART (CTCA in patients with suspected angina due to coronary heart disease: an open-label, parallel-group, multicentre trial) data to estimate the requirement for CTCA, for full guideline implementation. Details of CTCA-capable scanners were obtained from manufacturers and formally accredited practitioner details from professional societies.
Results:
An estimated 42 340 CTCAs are currently performed annually in the UK. We estimate that 350 000 would be required to fully implement the guidelines. 304 CTCA-capable scanners and 198 accredited practitioners were identified. A marked geographical variation between health regions was observed.
Conclusions:
This study provides insight into the scale of increase in the provision of CTCA required to fully implement the updated NICE guidelines. A small specialist workforce and limited number of CTCA-capable scanners may present challenges to service expansion.
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