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Re: The National Institute for Health and Care Excellence update for stable chest pain: poorly reasoned and risky for patients
  1. Adam Timmis1,
  2. Carl Roobottom2
  1. 1 NIHR Cardiovascular Biomedical Research Unit, Bart's Heart Centre, London, UK
  2. 2 Department of Radiology, Derriford Hospital, Plymouth, UK
  1. Correspondence to Professor Adam Timmis, NIHR Cardiovascular Biomedical Research Unit, Bart's Heart Centre, London EC1A 7BE, UK; a.d.timmis{at}

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Dear Editor, Cremer and Nissen have chosen to traduce the National Institute for Health and Care Excellence (NICE) guideline update in their editorial.1 The views they express are inaccurate and biased as summarised in the bulleted comments that follow:

  • Contrary to the assertion by Cremer and Nissen, the NICE guideline emphasises the importance of a careful history to guide the need for further diagnostic testing.

  • Nowhere does the NICE guideline state that assessing pretest probability (PTP) of disease is ‘useless’ or that Bayesian analysis should be ‘abandoned’. It merely observes that regardless of age and gender, nearly all patients with atypical or typical chest pain have a PTP of disease between 10% and 90% by Genders’ …

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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