NICE CHALLENGE THAT IS DIFFICULT TO MEET?

IntroductionCurrent NICE guidelines recommend early invasive strategy with coronary angiography within 72 hours of first presentation of NSTEMI to those who have an intermediate or higher risk of adverse cardiovascular events, defined as a GRACE 2.0 risk greater than 3.0%. The aim of this audit is to explore NICE guideline adherence, patient characteristics and clinical outcomes.MethodsRetrospective data from patients with a final diagnosis of NSTEMI in the months of October 2018 and January 2019 was gathered from clinical coding. Patients were stratified by their GRACE 2.0 score, which was retrospectively calculated using their clinical notes and investigations on the Integrated Clinical Environment.ResultsThere were 116 patients of which 90 (77.6%) had an intermediate to high risk. Data was analysed for all the 90 patients (table 1) with further analysis for those who underwent early or late inpatient coronary angiography with fisher’s exact test (table 2). From the 90 patients 44 (48.9%) underwent coronary angiography, while 46 patients (51.1%) were not suitable for invasive intervention hence treated with standard medical therapy. 18 patients (40.9%) had coronary angiography within 72 hours and 26 waited more than 72 hours. 13 (72.2%) of those who had early coronary angiography went on to have percutaneous coronary intervention compared to the 10 (38.5%) patients who had delayed coronary angiography (p=0.0018).ConclusionDespite expectations there was only 40.9% adherence to NICE guideline. In contrast to expectations intermediate to high-risk patients are less likely to have early invasive strategy. However, there is no difference in outcome between an early versus late invasive strategy for inpatients. Standard medical treatment is still practiced at higher number of patients with multiple comorbidities, higher age and intermediate to high risk. This shows that meeting NICE recommendations can be challenging for numerous factors beyond a clinician’s control. Further data from medium sized district general hospitals with catheterization laboratory facility is needed to assess the overall ability of these centres to meet NICE recommendations.Conflict of InterestNone