Investigating Patients with Recent Onset of Chest Pain Against NICE Guidelines in a District General Hospital Setting in the United Kingdom

Background: Chest pain is a very common symptom leading to a significant number of patients visiting the primary care trusts, emergency departments and a huge number of emergency hospital admissions.Objective: The objective of our audit was to investigate whether patients with recent onset of chest pain referred to the Rapid Access Chest Pain Clinic were being investigated in accordance with the recommendations by the National Institute for Health and Clinical Excellence (NICE), in a busy District General Hospital setting.Design: Retrospective collection of dataSetting: Southend University Hospital NHS Foundation TrustPatients: We collected data over a period of three months for all the patients who underwent invasive coronary angiogram after being referred via Rapid Access Chest Pain Clinic (RACPC) or General Cardiology Clinic presenting with recent onset of chest pain. A total of 157 patients were enrolled in the study. The patients were then categorised into four groups based upon their description of symptoms, age and risk factors, as defined by NICE.Results: We found that 86% (135/157) patients had estimated likelihood of CAD >60% and 51% of these had unnecessary non-invasive investigations contrary to what NICE recommends. This shows that adhering to the NICE guidelines would have saved a substantial amount of hospital resources and time of the healthcare team and the patients.Conclusions: The development of strategies for cost-conscious quality care must begin with the history, risk factors for coronary artery disease and patients’ investigations should be based on their risk stratification.