17 Comparison of nice clinical guidelines 95 2010 and 2016: a single centre experience. (15th May 2019)

• Record Type: Journal Article
• Authors: Wettasinghe, Mihiri Chami; Wickramasinghe, Nuwan Darshana; Deshpande, Aparna
• Is Part Of: Heart. Volume 105(2019)Supplement 5
• Page Start: A8
• Page End: A8
• Publication Date: 2019-05-15
• Subjects: Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2019-BSCI.17
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Introduction: This study was aimed at assessing the effectiveness of updated NICE clinical guidelines 95 2016 (CG95 2016) in comparison to NICE CG95 2010. Methods: This study was carried out at the University Hospitals of Leicester NHS Trust by analysing retrospective data collected from the hospital electronic database. Statistical significance of the differences of mean number of investigations, investigation cost, functional studies and radiation exposure between the 2010 and 2016 groups were assessed. Results: There were 487 and 557 patients in the 2010 and 2016 groups respectively. While there were statistically significant (p<0.001) increases in the mean investigations and the mean radiation exposure in CG95 2016 group, the mean cost of investigations (p<0.001) and the mean number of functional studies (p=0.030) were less in CG95 2016 group. 565 patients had a zero calcium score and only three (0.5%) were positive for ischaemia on subsequent functional imaging. In the CG95 2010 group, 341(70.0%) had a risk score of < 30%. Of the 231 (67.7%) who had a zero calcium score, only two (0.7%) were positive for ischaemia on subsequent imaging. Conclusion: The increase in the number of CT coronary angiograms (CTCA) performed in CG95 2016 group is likely leading to increase in mean radiation dose and mean investigations per patient. We propose that if the risk score is <30%, calcium score should be performed as the first line investigation. If calcium score is zero, further investigation with CTCA is not recommended unless there remains clinical concern for coronary artery disease.