NICE clinical guideline: chest pain of recent onset

Abstract

Chest pain is a common presentation in general practice: in the UK, up to 1% of visits to a GP are due to chest pain.1 Chest pain matters: the risk of death is doubled in the year following a new presentation with chest pain in general practice.1 The recently published guideline from the National Institute for Health and Clinical Excellence (NICE), Chest Pain of Recent Onset: Assessment and Diagnosis of Recent Onset Chest Pain or Discomfort of Suspected Cardiac Origin ,2 addresses the assessment and diagnosis of patients with recent-onset chest pain (or discomfort) that may be of cardiac origin. It does not make recommendations for the management of the condition once the diagnosis is made. The NICE unstable angina and non-ST elevation myocardial infarction (NSTEMI) clinical guideline3 was published at the same time as the chest pain guideline; local protocols are recommended for management of STEMI, and a NICE clinical guideline for the management of stable angina is currently being prepared.4 The chest pain guideline has two separate diagnostic pathways. The first is for patients with acute chest pain who may have an acute coronary syndrome (ACS), and the second for those with intermittent stable chest pain who may have stable angina. The need to provide information to patients (and, where appropriate, their family or carer/advocate) and to involve them in decisions is emphasised throughout. The recommendations around acute and ‘acute but not current’ (that is, recent pain but currently pain free) chest pain are summarised in Boxes 1 and 2. For chronic stable chest pain, a key aspect of the guideline of particular relevance to primary care is the recommendation that formal risk stratification of the likelihood of coronary artery disease (CAD) be undertaken, based on aspects of the history (Box 3 …