Investigating Patients with Recent Onset of Chest Pain Against NICE Guidelines in a District General Hospital Setting in the United Kingdom

AUDIT REPORT, November 2012, VOL II ISSUE II, ISSN 2042-4884
10.5083/ejcm.20424884.85 , Cite or Link Using DOI
Creating a Digital Object Identifier Link

A digital object identifier (DOI) can be used to cite and link to electronic documents. A DOI is guaranteed never to change, so you can use it to link permanently to electronic documents.

To find a document using a DOI

  1. Copy the DOI of the document you want to open.
    The correct format for citing a DOI is as follows: doi:10.1016/S0140-6736(08)61345-8
  2. Open the following DOI site in your browser:
    dx.doi.org
  3. Enter the entire DOI citation in the text box provided, and then click Go.
    The document that matches the DOI citation will display in your browser window.

The DOI scheme is administered by the International DOI Foundation. Many of the world's leading publishers have come together to build a DOI-based document linking scheme known as CrossRef.

Azeem S Sheikh, Kamran Ali, Azhar A Khokhar

Background: Chest pain is a very common symptom leading to a significant number of patients visiting the primary care trusts, emergency departments and a huge number of emergency hospital admissions.

Objective: The objective of our audit was to investigate whether patients with recent onset of chest pain referred to the Rapid Access Chest Pain Clinic were being investigated in accordance with the recommendations by the National Institute for Health and Clinical Excellence (NICE), in a busy District General Hospital setting.

Design: Retrospective collection of data

Setting: Southend University Hospital NHS Foundation Trust

Patients: We collected data over a period of three months for all the patients who underwent invasive coronary angiogram after being referred via Rapid Access Chest Pain Clinic (RACPC) or General Cardiology Clinic presenting with recent onset of chest pain. A total of 157 patients were enrolled in the study. The patients were then categorised into four groups based upon their description of symptoms, age and risk factors, as defined by NICE.

Results: We found that 86% (135/157) patients had estimated likelihood of CAD >60% and 51% of these had unnecessary non-invasive investigations contrary to what NICE recommends. This shows that adhering to the NICE guidelines would have saved a substantial amount of hospital resources and time of the healthcare team and the patients.

Conclusions: The development of strategies for cost-conscious quality care must begin with the history, risk factors for coronary artery disease and patients’ investigations should be based on their risk stratification.