HNY Policy and Pathway Repository - Hull

Screening for Coronary heart disease in asymptomatic patients OR to diagnose or exclude angina for people without known Coronary heart disease

This intervention is not routinely commissioned and therefore should not be offered to patients. Application for funding approval can be made, using the IFR process, by the clinician recommending the intervention, if their assessment is that there are exceptional reasons why their patient could benefit from it.

 

N.B. This policy does not apply to patients already diagnosed with Coronary heart disease if a cardiologist advises use of the test to confirm functional capacity or severity.

In randomised control trials, screening with exercise ECG in asymptomatic patients found no improvement in health outcomes, even when focussing on higher risk populations such as those with diabetes. Exercise ECG screening has instead been associated with potential harms due to false-positive results leading to potentially unnecessary tests and procedures.

 

The US Preventative Service Task Force recommends against screening for CHD with resting or exercise ECG in adults at low risk for CHD events.

In asymptomatic but high-risk adults (with diabetes, a strong family history of CVD, or when previous risk-assessment tests suggest a high risk of CVD), functional imaging or coronary CTA may be considered for cardiovascular risk assessment.

 

For people with typical or atypical cardiac chest pain, and subject to specific criteria, NICE recommends CT coronary angiography (1st line), non-invasive functional testing (2nd line) or invasive coronary angiography (3rd line) for diagnosis.

Exercise electrocardiogram (ECG) for screening for coronary heart disease - EBI

Screening for Cardiovascular Disease Risk With Electrocardiography: US Preventive Services Task Force Recommendation Statement JAMA

CG95 Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis NICE