Published 24 December 2008, doi:10.1136/bmj.a3097
Cite this as: BMJ 2008;337:a3097

Letters

Exercise ECGs in angina

Cost effective investigation of suspected angina

The first 150 words of the full text of this article appear below.

How might exercise electrocardiography (ECG) fare in the sort of technology appraisal to which more modern technologies have been subjected? Although it is widely available and comparatively cheap, its diagnostic power is limited and its incremental prognostic power over clinical assessment is poor.^{1 2}

In contrast, the National Institute for Health and Clinical Excellence (NICE) found myocardial perfusion scintigraphy to be both effective and cost effective in assessing patients presenting with possible stable angina.³ Clinical and modelling studies have shown that a strategy that omits exercise ECG and goes straight to myocardial perfusion scintigraphy is cost effective, particularly in the intermediate likelihood group of patients who are commonly seen in rapid access chest pain clinics.⁴ Similarly, in the lower likelihood group, cost effective practice is to follow initial exercise ECG with myocardial perfusion scintigraphy if further investigation is required.

It is therefore understandable but not entirely evidence based to conclude that . . . [Full text of this article]

¹ Imperial College London, Royal Brompton Hospital, London SW3 6MP

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