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The waiting game

NICE chest pain guidance 'could cause dangerous diagnosis delays'

By Nigel Praities

NICE draft guidelines on the management of chest pain could result in dangerous delays in the diagnosis of patients, new research suggests.

The study shows an increase in all-cause mortality in patients whose diagnosis is delayed after leaving a chest pain clinic without a conclusive exercise ECG test.

Draft guidelines released by NICE last month ruled exercise stress testing was ‘generally not helpful' in diagnosing patients with stable angina.

Instead, the guidelines recommend GPs send patients without a firm diagnosis of angina after clinical assessment for angiography, functional imaging or calcium scoring rather than undergo exercise testing.

GPs warned when the guidelines were released that this could lead to major delays in diagnosing patients, and research from Manchester Heart Centre now suggests these delays may push up death rates.

The researchers – who presented their research at the British Cardiovascular Society meeting in London last month – followed 2,200 patients attending a rapid access chest pain clinic in Manchester.

They found patients unable to exercise or with an inconclusive exercise ECG were marked out as at significantly increased risk of all-cause mortality.

Dr Rajdeep Khattar, consultant cardiologist at Manchester Royal Infirmary and an author on the study, said the NICE guidance was ‘very controversial' and would require a full-scale service redesign to fast-track patients.

‘This shows if you come to a chest pain clinic and leave without an answer as to whether you have coronary artery disease or not you are at a higher risk of death.

‘The reality with the NICE guidance is that most district general hospitals will not be able to provide you access to any of the other tests at the moment,' he said.

Dr Khattar said patients were waiting for three or four months for the next diagnostic test and were having an event in the meantime.

Dr Kathryn Griffith, a GP in York and president elect of the Primary Care Cardiovascular Society, said: ‘If patients haven't done a very good treadmill test, then what could the reasons be? You have got to look into them.'

Dr Kathryn Griffith

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