Radical changes to the investigation of stable chest pain following the 2016 NICE update.

The 2016 National Institute for Health and Care Excellence (NICE) guidelines mark a radical change in the diagnosis of patients with stable chest pain. Quantitative assessments of the disease probability are no longer considered necessary to determine the need and type of diagnostic testing. Instead, the recommendation is for no diagnostic test if the chest pain is judged to be "non-anginal" and CT coronary angiography (CTCA) in patients with "typical" or "atypical" chest pain. The new emphasis on anatomical, rather than functional testing is driven by the accuracy, safety and cost effectiveness of the different investigations as evaluated by NICE. Despite inevitable resource implications NICE calculates that annual savings will be significant.