Clinician referrals for stress echocardiography: are we compliant with the NICE guidelines?

Accurate diagnosis of stable angina is of paramount importance, and where possible, this should be based on clinical history. In cases of uncertainty, the National Institute for Health and Care Excellence (NICE) provides a framework for assisting diagnosis based on pre-test likelihood (PTL) of coron...

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Bibliographic Details
Published in:	Echo research and practice Vol. 1; no. 1; pp. 17 - 21
Main Authors:	Patel, P A, Ravi, K A, Ripley, D P, Kane, J, Wass, E, Carr, A, Wilson, D, Watchorn, N, Hobman, R K, Gill, D, Brooksby, W P, Kilcullen, N, Artis, N
Format:	Journal Article
Language:	English
Published:	England Bioscientifica Ltd 01-09-2014 Springer Nature B.V
Subjects:	Cardiovascular disease NICE stress echocardiography chest pain stable angina
Online Access:	Get full text
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Summary:	Accurate diagnosis of stable angina is of paramount importance, and where possible, this should be based on clinical history. In cases of uncertainty, the National Institute for Health and Care Excellence (NICE) provides a framework for assisting diagnosis based on pre-test likelihood (PTL) of coronary artery disease. Functional testing such as stress echocardiography (SE) is recommended as a first-line investigation in patients with PTL of 30–60%. This study evaluated hospital clinicians' adherence to this recommendation. A prospective analysis of patients referred for SE at a district general hospital between March and May 2013 was performed. Data were extracted from an electronic database of SE reports and medical notes. A total of 193 patients were assessed. The most common PTL was 61–90%, accounting for 40% of the cohort. Of them, 14% had a PTL of 30–60%. Of these, 15% had positive SE; 57% described non-anginal pain, as defined by NICE, of whom only nine cases had SE positivity. None of these patients required revascularisation. Findings suggest that SE is being used in a much broader selection group than advocated by NICE. This may often be for its exclusion value rather than to stratify risk. Although utility may be justified in high-risk patients to avoid proceeding directly to invasive angiography, SE appears to add little in those with non-anginal pain and with low PTL. Greater focus should be directed towards characterisation of symptoms, which may negate the need for subsequent investigation.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2055-0456 2055-0464 2055-0464
DOI:	10.1530/ERP-14-0028