Challenges in delivering computed tomography coronary angiography as the first-line test for stable chest pain
Challenges in delivering computed tomography coronary angiography as the first-line test for stable chest pain
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DOI：
10.1136/heartjnl-2017-311846
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发表时间：
2018-06-01
期刊：
影响因子：
5.7
通讯作者：
Roditi, Giles
中科院分区：
文献类型：
--
作者：
Dreisbach, John G.;Nicol, Edward D.;Roditi, Giles
目的美国国家健康与护理卓越研究所（NICE）临床指南“近期发作的胸痛：评估和诊断”（2016年更新）指出，CT冠状动脉造影（CTCA）应作为稳定性胸痛患者的一线检查。然而，英国目前的规定尚不清楚。我们的目的是评估这一点，并估计全面实施指南的要求，包括地理差异。辅助目标包括调查CTCA能力的扫描仪和认可的从业人员在UK.Methods每年进行的CTCA扫描的数量进行了调查，在整个国家卫生服务（NHS）。将2015年NHS中针对稳定型心绞痛进行的经皮冠状动脉介入治疗的数量应用于基于SCOT-HEART（冠心病疑似心绞痛患者的CTCA：一项开放标签、平行组、多中心试验）数据的模型，以估计CTCA的要求，以全面实施指南。CTCA功能的扫描仪的详细信息，从制造商和正式认可的从业人员的详细信息，从专业society.Results估计42 340 CTCA目前每年在英国进行。我们估计需要35万人才可全面实施这些指引。确定了304台具备CTCA能力的扫描仪和198名经认证的从业人员。一个显着的地理变化之间的健康regions.Conclusions本研究提供了深入了解的规模增加的CTCA的提供需要全面实施更新的尼斯指南。专家队伍规模小，具备CTCA功能的扫描仪数量有限，可能会对服务扩展构成挑战。
Objective 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.Methods 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.Results 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.Conclusions 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.