Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Sep 1;1(1):17-21.
doi: 10.1530/ERP-14-0028. Epub 2014 Jul 9.

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

P A Patel  1 , K A Ravi  1 , D P Ripley  1 , J Kane  1 , E Wass  1 , A Carr  1 , D Wilson  1 , N Watchorn  1 , R K Hobman  1 , D Gill  1 , W P Brooksby  1 , N Kilcullen  1 , N Artis  1
Affiliations

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

P A Patel et al. Echo Res Pract. .

Abstract

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.

Keywords: NICE; chest pain; stable angina; stress echocardiography.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Distribution of referrals for stress echocardiography by typicality of symptoms.
Figure 2
Figure 2
Correlation of pre-test likelihood (PTL) with typicality of symptoms.
Figure 3
Figure 3
Correlation of pre-test likelihood (PTL) with stress echo positivity.
See this image and copyright information in PMC

References

    1. Nilsson S Scheike M Engblom D Karlsson LG Molstad S Akerlind I Ortoft K Nylander E Chest pain and ischaemic heart disease in primary care British Journal of General Practice 53 2003. 378–382. - PMC - PubMed
    1. Klinkman MS Stevens D Gorenflo DW Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Network Journal of Family Practice 38 1994. 345–352. - PubMed
    1. Department of Health 2000 National Service Framework for Coronary Heart Disease. In National Service Frameworks Department of Health: London, UK. (available at: https://www.gov.uk/government/publications/quality-standards-for-coronar...; accessed 16 April 2014)
    1. National Institute for Health and Care Excellence 2010 Assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin (CG95). NICE: London, UK (available at: http://www.nice.org.uk/guidance/CG95; accessed 24 April 2014). - PubMed
    1. Diamond GA Staniloff HM Forrester JS Pollock BH Swan HJ Computer-assisted diagnosis in the noninvasive evaluation of patients with suspected coronary artery disease Journal of the American College of Cardiology 1 1983. 444–455.10.1016/S0735-1097(83)80072-2 - DOI - PubMed

LinkOut - more resources