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February is Heart Month. As a former cardiac ultrasound tech with hundreds of hours supporting interventionalists in the cath lab, I am reminded of the importance of cardiovascular health and how to improve care pathways and health outcomes for patients facing cardiovascular disease. The international chest pain guidelines recently released have the potential to achieve both.
In the 2021 AHA/ACC/ASE/CHEST/SAEM/ SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain, there's a particular focus on contemporary imaging modalities for risk assessment and management planning in patients with stable or acute chest discomfort. One of the significant shifts in the guideline is the elevated role of coronary CTA (CCTA) for the non-invasive assessment of these patients. In fact, coronary CTA is the only non-invasive testing modality given a Class 1 recommendation supported by Level A quality of evidence. Other widely used modalities such as stress echo are classified lower than CTA, as Class 1 but with Level B quality of evidence.
Physicians across the country now can recommend coronary computed tomography angiography (CCTA) as a frontline test for their patients if they judge these patients to be stable with acute chest pain and no known coronary artery disease.
An important evidence-based option for physicians and the patients in their care, these guidelines mean patients may now receive a CCTA test in the emergency department that may more quickly allow clinicians to take the worst fears off the table and ultimately get patients home sooner. Unlike in the past, perhaps they don't need to be rushed to the cardiac catheterization lab for an invasive test through an incision in their groin. In addition, they may not need to spread the word to their alarmed family that they will be staying overnight, with scheduled stress and exercise tests coming together and a worry over what may be coming next.
The new guidelines, formulated by the American College of Cardiology (ACC) and the American Heart Association (AHA), together with the American Society of Echocardiography (ASE), Society of Cardiovascular Computed Tomography (SCCT), Society of Cardiovascular Magnetic Resonance (SCMR), the American College of Chest Physicians (CHEST), and the Society for Academic Emergency Medicine (SAEM) are an essential step toward better, harmonized care and decision-making for all cardiac patients.