• heart disease

In a patient with recent onset chest pain symptoms, updated National Institute for Health and Care Excellence guidelines recommend computed tomographic coronary angiography (CTCA) as the initial diagnostic test when clinical features are consistent with typical or atypical angina or when atypical chest pain is accompanied by ECG changes suggesting ischaemia. Yet, it is not clear whether a CTCA study can be provided to all patients who meet these criteria. In this issue of Heart, Dreisbach and colleagues1 report that currently only about 42 000 CTCAs are performed annually in the UK using 304 CTCA-capable scanners, interpreted by 198 accredited practitioners. They estimate that an additional 350 000 scans (545 per 100 000 population) would be required to fully implement these new guidelines (figure 1). Thus, there is a considerable shortage of both CTCA-capable scanners and qualified practitioners.

In an editorial, Cremer2 expresses doubts about the recommendation to use CTCA as the first-line diagnostic test for suspected coronary artery disease, especially given that ‘the UK is ill prepared both in terms of trained personnel and …