128 MORE DISCHARGES, LESS FOLLOW-UP AND SIMILAR RATES OF CORONARY ANGIOGRAPHY: INITIAL ‘REAL-WORLD’ EXPERIENCE OF NICE GUIDANCE ON ASSESSMENT OF CHEST PAIN OF RECENT ONSET IN THE RAPID ACCESS CHEST PAIN CLINIC
Notice bibliographique
Résumé
<h3>Introduction</h3> In March 2010 NICE clinical guideline number 95 described a new protocol-driven pathway for the investigation of chest pain of recent onset. This emphasised the importance of establishing pre-test probability of coronary artery disease and encouraged the use of non-invasive coronary and myocardial perfusion imaging. We sought to determine the impact of these changes on resource utilisation in particular coronary angiography and need for out-patient review. <h3>Methods</h3> Clinical disposition for patients attending the nurse-led Rapid access chest pain clinic (RACPC) at Royal Derby hospital between January and August 2011 was analysed using a dedicated database. During this period an established exercise tolerance test-driven protocol was in place. The proposed NICE RACPC protocol was applied retrospectively to this cohort to produce a projected model of outcomes. The new RACPC protocol was implemented in July 2012 and disposition was recorded prospectively for 9real-world9 patients attending between July and November 2012. Proportions were compared with Pearson9s χ<sup>2</sup> test and p value of <0.05 was taken to be significant. <h3>Results</h3> Results are summarised in figure 1. A total of 916 patients were analysed: 360 patients attended RACPC between July and November 2012 and 556 during 2011. Of these 517 (56.4%) were male. 364 (39.7%) were deemed inappropriate referrals by NICE criteria and were discharged to the GP. Typical angina was diagnosed in 191 (20.8%) and non-angina symptoms in 333 (36.4%). 562 (61.4%) underwent a treadmill exercise tolerance test, of which 136 (14.9%) were reported as positive for ischaemia. Implementation of the new protocol-driven RACPC pathway during 2012 resulted in a significant reduction in cardiology clinic follow-up compared with 2011 (2% vs 23%, p<0.0001). Rates of discharge to the GP upon initial consultation were higher (67.5% vs 60%, p=0.02) with fewer direct admissions from RACPC (3% vs 6%, p=0.008), whereas the rate of coronary angiography (10.3% vs 8%, p=0.57) was similar. The rate of myocardial perfusion scanning remained similar (9.2% vs 6%, p=0.13) while uptake of CT coronary angiography currently was lower than predicted by NICE at 2.5%. Observed rates of angiography and MPS during 2012 were similar to those predicted by the NICE retrospective model. <h3>Conclusions</h3> In this ‘real-world9 study, implementation of the 2010 NICE guidance on the initial evaluation of chest pain of recent onset with a protocol-driven RACPC pathway resulted in a greater proportion of initial discharge to primary care with less frequent outpatient review and similar rates of referral for coronary angiography. Utilisation of non-invasive coronary imaging in the initial assessment of chest pain is likely to expand and longitudinal outcome studies are required to confirm the safety of revised RACPC protocols.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».