New guidelines on acute chest pain

31 March 2010

New guidelines aimed at improving the assessment and diagnosis of patients with recent onset chest pain/discomfort of suspected cardiac origin are expected to reduce premature deaths.

The guidelines were developed jointly by NICE and the National Clinical Guidelines Centre for Acute and Chronic Conditions and represent a significant change in practice in some key areas of diagnosing an acute coronary syndrome (ACS) and angina.

Chest pain is a very common symptom with some 20-40% of the general population experiencing it during their lives, accounting for up to 1 per cent of visits to GPs, 5 per cent to emergency departments and up to 25 per cent of emergency admissions to hospital. Patients with chest pain due to an acute coronary syndrome (ACS) or angina are particularly at risk but there are effective treatments to improve symptoms and prolong life.

The guidelines have two separate diagnostic pathways for patients with acute chest pain who may have an ACS (such as a heart attack or unstable angina) and for those with intermittent stable chest pain of suspected cardiac origin who may have stable angina.

Professor Adam Timmis, Consultant Interventional Cardiologist and Chair of the Guideline Development Group, said: "This guideline emphasises the central role of the initial clinical assessment in diagnosing cardiac causes of chest pain. It provides objective clinical criteria for determining whether diagnostic testing is necessary and if so what test should be used. The guideline will improve clinical decision making in patients with suspected angina, identifying those who might benefit from treatment to reduce risk and improve outcomes."

Link: Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin