Assessment of patients with stable chest pain

Learning objectives Chest pain is a frequent symptom at presentation in both primary and secondary care. There are several international guidelines available for patients with stable chest pain including the NICE (National Institute for Health and Care Excellence) guidelines ‘Chest pain of recent onset’ which were updated in 2016,1 2 the 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS ‘Guidelines for the diagnosis and management of patients with stable ischemic heart disease’ for which there was a focused update in 2014,3 4 and the 2013 ESC (European Society of Cardiology) ‘Guidelines for the management of stable coronary artery disease’.5 In this article, we will highlight the 2016 NICE guidelines for the diagnosis of stable chest pain including assessment of clinical findings, risk stratification models, and invasive and non-invasive investigations. It is important to appreciate that the 2016 guidelines were an update of the 2010 guidelines, not a full revision, and only certain aspects were reassessed; this review focuses on these sections. We will also highlight similarities and difference between the other international guidelines. ### Patient population Cardiovascular disease remains an important cause of morbidity and mortality globally and was the second most common cause of death in the UK in 2014.6 Although mortality from coronary artery disease (CAD) is decreasing, the prevalence of CAD has remained relatively constant between 3% and 4%.7 Chest pain is a frequent symptom …