New NICE guidelines for the management of stable angina.

Abstract

In November 2016, the National Institute for Health and Care Excellence (NICE) released an update of its 2010 Clinical Guideline CG951 on patients presenting with stable chest pain.2 This article covers the main changes in the updated CG95, and comments on how GPs can expect the management of patients referred to a cardiology/rapid-access chest pain clinic (RACPC) to change. Accurate assessment of patients presenting with chest pain is challenging. The combination of a detailed clinical history of the pain, with concomitant risk factors provides the most accurate clinical assessment.3,4 The 2010 guidance used pre-test probability scoring to guide patient investigation and management. The 2016 NICE guidelines do not advocate this and rely on a purely qualitative approach because all those with a clinical suspicion of angina will be investigated the same way. Presenting symptoms are divided into ‘typical’ and ‘atypical’. ‘Typical’ chest pain is classified as including all three of the following features: 1. Constricting discomfort in the front of the chest, or in the neck, shoulders, jaw, or arms; 2. Precipitated by physical exertion; and 3. Relieved by rest or sublingual nitrate within approximately 5 minutes. ‘Atypical’ pain is suggested by any two of the above, whereas ‘non-anginal’ pain is described as one or fewer. In the event of pain being classified as ‘non-anginal’, a diagnosis of stable angina can be excluded unless other features within the history or the risk factor profile (Box 1 …