NICE guidance. Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin.

Chest pain is a very common symptom; 20% to 40% of the general population will experience chest pain during their lives, and in theUK,up to 1%of visits to a general practitioner are because of chest pain. Approximately 700 000 visits (5%) to the emergency department in England and Wales and up to 25% of emergency hospital admissions are because of chest pain. There are many causes of chest pain, some of which are benign, while others are potentially life threatening. Importantly, in patientswith chest pain caused by an acute coronary syndrome (ACS) or angina, there are effective treatments to improve symptoms and prolong life, emphasising the importance ofmaking timely and accurate diagnoses in patients in whom chest pain may be of cardiac origin. This guideline addresses the assessment and diagnosis of patients with recent onset chest pain/ discomfort that may be of cardiac origin. Unlike many other National Institute for Health and Clinical Excellence (NICE) clinical guidelines it does not make recommendations for the management of the condition once the diagnosis is made. The NICE unstable angina andNSTEMI clinical guideline was published at the same time as the chest pain guideline, and a NICE clinical guideline for the management of angina is currently being prepared. The guideline has two separate diagnostic pathways. The first is for patients with acute chest pain whomay have an ACS and the second for those with intermittent stable chest pain who may have stable angina. The guideline deals with chest pain of suspected cardiac origin. Thus, for example, the guideline does not apply to patients with pain considered tobe causedby recent trauma to the chest. However, many patients presenting with chest pain do not have such clearly apparent alternative explanations and need to have a cardiac cause considered. The guideline has three main sections. The first addresses what information to provide to patients with chest pain, the second diagnosis in patients with a possible ACS and the third diagnosis in patients with possible stable angina. NICE guidelines also include up to 10 recommendations that the guideline development group agree will have most impact on current clinical practice (box 1).