Consensus document on chronic coronary syndrome assessment and risk stratification in Portugal: A position paper statement from the [Portuguese Society of Cardiology's] Working Groups on Nuclear Cardiology, Magnetic Resonance and Cardiac Computed Tomography, Echocardiography, and Exercise Physiology and Cardiac Rehabilitation

Abstract

Despite constant medical evolution, the reimbursement policy of Portuguese National Health Service (NHS) for the study and risk stratification of coronary heart disease has remained unchanged for several decades. Lack of adjustment to contemporary clinical practice has long been evident. However, the recent publication of the European Guidelines for diagnosis and treatment of chronic coronary syndromes further highlighted this gap and the urgent need for a change. Prompted by these Guidelines, the Working Group on Nuclear Cardiology, Cardiac Magnetic Resonance and Cardiac CT, the Working Group on Echocardiography and the Working Group on Stress Pathophysiology and Cardiac Rehabilitation of the Portuguese Society of Cardiology, began a process of joint reflection on the current limitations and how these recommendations could be applied in Portugal. To this end, the authors suggest that the new imaging methods (stress echocardiogram, cardiac computed tomography and cardiac magnetic resonance), should be added to exercise treadmill stress test and myocardial perfusion scintigraphy in the available exam portfolio within the Portuguese NHS. This change would allow full adoption of European guidelines and a better use of tests, according to clinical context, availability and local specificities. The adoption of clinical guidance standards, based on these assumptions, would translate into a qualitative improvement in the management of these patients and would promote an effective use of the available resources, with potential health and financial gains.

Keywords: Cardiac Imaging Techniques; Cardiovascular diagnostic techniques; Cintigrafia de perfusão miocárdica; Computed Tomography; Coronary Heart Disease; Cuidados de saúde primários; Doença coronária; Echocardiography; Ecocardiografia; Estratificação de risco; Guidelines; Magnetic Resonance; Myocardial scintigraphy; Positron Emission Tomography; Primary Health Care; Prova de esforço; Recomendações; Ressonância magnética; Risk assessment; Tomografia computorizada; Tomografia de emissão de positrões; Treadmill Test; Técnicas de diagnóstico cardiovascular; Técnicas de imagiologia cardíaca.