Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK.
Department of Cardiology, Royal Brompton Hospital, London, UK.
Heart. 2018 Jun;104(11):921-927. doi: 10.1136/heartjnl-2017-311846. Epub 2017 Nov 14.
The National Institute for Health and Care Excellence (NICE) clinical guidelines 'chest pain of recent onset: assessment and diagnosis' (update 2016) state CT coronary angiography (CTCA) should be offered as the first-line investigation for patients with stable chest pain. However, the current provision in the UK is unknown. We aimed to evaluate this and estimate the requirements for full implementation of the guidelines including geographical variation. Ancillary aims included surveying the number of CTCA-capable scanners and accredited practitioners in the UK.
The number of CTCA scans performed annually was surveyed across the National Health Service (NHS). The number of percutaneous coronary interventions performed for stable angina in the NHS in 2015 was applied to a model based on SCOT-HEART (CTCA in patients with suspected angina due to coronary heart disease: an open-label, parallel-group, multicentre trial) data to estimate the requirement for CTCA, for full guideline implementation. Details of CTCA-capable scanners were obtained from manufacturers and formally accredited practitioner details from professional societies.
An estimated 42 340 CTCAs are currently performed annually in the UK. We estimate that 350 000 would be required to fully implement the guidelines. 304 CTCA-capable scanners and 198 accredited practitioners were identified. A marked geographical variation between health regions was observed.
This study provides insight into the scale of increase in the provision of CTCA required to fully implement the updated NICE guidelines. A small specialist workforce and limited number of CTCA-capable scanners may present challenges to service expansion.
英国国家卫生与保健优化研究所（NICE）临床指南“近期发作胸痛：评估与诊断”（2016 年更新）指出，对于稳定型胸痛患者，应将 CT 冠状动脉造影（CTCA）作为一线检查方法。然而，目前在英国的实际服务提供情况尚不清楚。我们旨在评估这一情况，并估算完全实施指南的要求，包括地域差异。辅助目标包括调查英国 CTCA 能力扫描仪和认证从业人员的数量。
在国民保健制度（NHS）范围内调查每年进行的 CTCA 扫描数量。将 NHS 中 2015 年稳定型心绞痛经皮冠状动脉介入治疗的数量应用于基于 SCOT-HEART（因冠心病导致疑似心绞痛患者的 CTCA：一项开放性、平行组、多中心试验）数据的模型，以估算完全实施指南所需的 CTCA 数量。从制造商处获取 CTCA 能力扫描仪的详细信息，并从专业协会获取正式认证从业人员的详细信息。
目前，英国每年约进行 42340 例 CTCA。我们估计，要完全实施指南，需要 35 万例 CTCA。共确定了 304 台 CTCA 能力扫描仪和 198 名认证从业人员。各卫生区域之间存在明显的地域差异。
本研究深入了解了为完全实施更新后的 NICE 指南而需要增加 CTCA 服务的规模。专业人员队伍规模较小且具备 CTCA 能力的扫描仪数量有限，可能对服务扩展构成挑战。
