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Assessment of patients with stable chest pain
  1. Michelle C Williams1,
  2. James Shambrook2,
  3. Edward D Nicol3,4
  1. 1University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  2. 2Department of Cardiothoracic Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  3. 3Departments of Cardiology and Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  4. 4Faculty of Health Sciences, National Heart and Lung Institute, Imperial College London, London, UK
  1. Correspondence to Dr Edward D Nicol, Department of Cardiology and Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK; e.nicol{at}nhs.net

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Learning objectives

  • Knowledge of national and international guidelines for the assessment of patients with stable chest pain, including the 2016 update to the NICE (National Institute for Health and Care Excellence) guidelines.

  • Understand the pros and cons of investigation of stable chest pain based on risk stratification models.

  • Knowledge of the advantages and disadvantages of non-invasive diagnostic tests for stable chest pain.

  • Understand important considerations involved in the choice of diagnostic test including factors relating to the patient and the diagnostic test.

Introduction

Chest pain is a frequent symptom at presentation in both primary and secondary care. There are several international guidelines available for patients with stable chest pain including the NICE (National Institute for Health and Care Excellence) guidelines ‘Chest pain of recent onset’ which were updated in 2016,1 2 the 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS ‘Guidelines for the diagnosis and management of patients with stable ischemic heart disease’ for which there was a focused update in 2014,3 4 and the 2013 ESC (European Society of Cardiology) ‘Guidelines for the management of stable coronary artery disease’.5 In this article, we will highlight the 2016 NICE guidelines for the diagnosis of stable chest pain including assessment of clinical findings, risk stratification models, and invasive and non-invasive investigations. It is important to appreciate that the 2016 guidelines were an update of the 2010 guidelines, not a full revision, and only certain aspects were reassessed; this review focuses on these sections. We will also highlight similarities and difference between the other international guidelines.

Patient population

Cardiovascular disease remains an important cause of morbidity and mortality globally and was the second most common cause of death in the UK in 2014.6 Although mortality from coronary artery disease (CAD) is decreasing, the prevalence of CAD has remained relatively constant between 3% and 4%.7 Chest pain is a frequent symptom …

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