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The Authors' reply
  1. Huon H Gray1,
  2. Robert A Henderson2,
  3. Mark A de Belder3,
  4. S Richard Underwood4,
  5. A John Camm5
  1. 1Department of Cardiology, Southampton University Hospital, Southampton, UK
  2. 2Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
  3. 3Department of Cardiology, Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK
  4. 4Department of Nuclear Medicine, Royal Brompton Hospital, University of London, London, UK
  5. 5Department of Cardiac and Vascular Sciences, St Georges Hospital, University of London, London, UK
  1. Correspondence to Dr Huon H Gray, Department of Cardiology, Southampton University Hospital, Tremona Rd, Southampton SO16 6YD, UK; huon{at}

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The Authors' reply We thank Dr Roberts and colleagues1 for their comments regarding the National Institute for Health and Clinical Excellence (NICE) clinical guidance 94 (CG94) on unstable angina and non-ST elevation myocardial infarction, which we have summarised in an earlier issue of Heart.2

We agree that risk scores should not be used in isolation to determine patient management, and NICE stresses that their documents offer guidance and should not dictate clinical practice. One of the challenges faced by our guideline development group was to place the ‘vast bodies of evidence’, referred to by Dr Roberts, into a clinically relevant context because of the variability of design, recruited populations, reported outcomes and definitions of end points in published randomised trials. We used the hard outcome of death at 6 months from randomised trials, and registry …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed

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