Comparison of NICE and ESC proposed strategies on new onset chest pain and the contemporary clinical utility of pretest probability risk score
| Autor: | George Frederick Vaughan, Edith Avornyo, Tamim Akbari, Alexandros Papachristidis, Khaled Al Fakih, Jonathan Byrne, Tracey Griffiths, Emma Saunders, Mark J. Monaghan, Sarah Denny |
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| Rok vydání: | 2019 |
| Předmět: |
Male
lcsh:Diseases of the circulatory (Cardiovascular) system Computed Tomography Angiography Cost-Benefit Analysis stress echocardiography CT coronary angiography Nice Coronary Artery Disease 030204 cardiovascular system & hematology Chest pain Coronary Angiography Group B Coronary artery disease 0302 clinical medicine London Myocardial Revascularization 030212 general & internal medicine computer.programming_language education.field_of_study Framingham Risk Score Health Care Costs Middle Aged Prognosis Coronary Vessels Pre- and post-test probability ESC guidelines Heart Function Tests Practice Guidelines as Topic Female medicine.symptom Cardiology and Cardiovascular Medicine medicine.medical_specialty Population Context (language use) Risk Assessment Angina Pectoris 03 medical and health sciences Cost Savings Predictive Value of Tests Internal medicine Clinical Decision Rules medicine Humans NICE guidelines education Aged Retrospective Studies business.industry medicine.disease lcsh:RC666-701 Heart Disease Risk Factors business computer |
| Zdroj: | Open Heart Open Heart, Vol 7, Iss 1 (2020) |
| ISSN: | 2053-3624 |
| Popis: | AimsPatients with de novo chest pain are usually investigated non-invasively. The new UK-National Institute for Health and Care Excellence (NICE) guidelines recommend CT coronary angiography (CTCA) for all patients, while European Society of Cardiology (ESC) recommends functional tests. We sought to compare the clinical utility and perform a cost analysis of these recommendations in two UK centres with different primary investigative strategies.Methods—resultsWe compared two groups of patients, group A (n=667) and group B (n=654), with new onset chest pain in two neighbouring National Health Service hospitals, each primarily following either ESC (group A) or NICE (group B) guidance. We assessed the clinical utility of each strategy, including progression to invasive coronary angiography (ICA) and revascularisation. We present a retrospective cost analysis in the context of UK tariff for stress echo (£176), CTCA (£220) and ICA (£1001). Finally, we sought to identify predictors of revascularisation in the whole population.Baseline characteristics in both groups were similar. The progression to ICA was comparable (9.9% vs 12.0%, p=0.377), with similar requirement for revascularisation (4.0% vs 5.0%.; p=0.532). The average cost of investigations per investigated patient was lower in group A (£279.66 vs £325.77), saving £46.11 per patient. The ESC recommended risk score (RS) was found to be the only predictor of revascularisation (OR 1.05, 95% CI 1.04 to 1.06; pConclusionBoth NICE and ESC-proposed strategies led to similar rates of ICA and need for revascularisation in discrete, but similar groups of patients. The SE-first approach had a lower overall cost by £46.11 per patient, and the ESC RS was the only variable correlated to revascularisation. |
| Databáze: | OpenAIRE |
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