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NICE Guidance
The National Institute for Health and Care Excellence (NICE) in the United Kingdom (UK) recently
issued two final guidance statements. The first pertains to the assessment and diagnosis of
patients with recent onset chest pain (CG95). The second is on the use of the HeartFlow® FFRCT
Analysis to assess functional ischemia in these patients.
Patients with Recent Onset Chest Pain
The final CG95 guidance, issued in November 2016, recommends the use of coronary CT
angiography (CTA) as a frontline test for any patient whose clinical assessment indicates typical
or atypical angina chest pain.
When coronary CTA “has shown coronary artery disease of uncertain functional significance or is
non-diagnostic” the recommendations indicate that CCTA should be followed by a non-invasive
functional test.
Non-invasive Functional Testing: The HeartFlow FFRCT Analysis
NICE completed a Technology Assessment reviewing the use of the HeartFlow FFRCT Analysis
to aid clinicians in the diagnosis of functional ischemia. The final guidance issued in February
2017 states:
“The case for adopting HeartFlow FFRCT for estimating fractional flow reserve from
coronary CT angiography is supported by the evidence. The technology is non-
invasive and safe, and has a high level of diagnostic accuracy.”
“HeartFlow FFRCT should be considered as an option for patients with stable,
recent onset chest pain who are offered CCTA as part of the NICE chest pain
pathway. Using HeartFlow FFRCT may avoid the need for invasive coronary
angiography and revascularization.”
“Based on the current evidence and assuming there is access to appropriate CCTA
facilities, using HeartFlow FFRCT may lead to cost savings of £214 per patient.”
CT scan machine; Person with question mark over heart; 3D model of coronary artery bloodflow; HeartFlow logo
NICE Recommended Pathway for Patients with Recent Onset Chest Pain
Use CCTA as a frontline test for
When results of CCTA indicate CAD
The HeartFlow FFRCT Analysis
patients with typical or atypical
of uncertain functional significance or
non-invasively provides clinicians
chest pain, or abnormal 12-lead
are otherwise indeterminate, proceed
with functional information to aid
resting EKG.
with a non-invasive functional test*,
in diagnosing, vessel by vessel, the
such as the HeartFlow FFRCT Analysis.
existence of myocardial ischemia.
Avoidance of invasive
Significant cost reduction (~£214 per patient)
investigation and simplification
when compared to all other non-invasive
of patient pathway
functional tests
About NICE
NICE is part of the UK Department of Health and provides national guidance and quality
standards to improve health and social care throughout the UK. The organization publishes
guidelines in several topical areas including the use of health technologies within the UK’s
National Health Service (NHS) and clinical practice.
About the HeartFlow FFRCT Analysis
The HeartFlow FFRCT Analysis is the first non-invasive diagnostic tool that aids clinicians in
determining, vessel by vessel, both the extent of an artery’s narrowing and the impact that the
narrowing has on blood flow to the heart.
For more information on NICE and the final guidance on HeartFlow FFRCT, please visit www.nice.org.uk.
*The NICE Committee reviewed common functional tests in use (e.g., SPECT, CCTA, ECHO, MRI, and ICA) to assess
suspected CAD. In all cases, the HeartFlow FFRCT Analysis was found to be significantly more cost effective while also
providing clinicians with improvements in diagnostic specificity and/or sensitivity.
Addendum to Clinical Guideline (CG95), Chest pain of recent onset: Assessment and diagnosis. Clinical Guideline
Addendum: CG95.1, November 2016.
National Institute for Health and Care Excellence (2017). HeartFlow FFRCT for estimating fractional flow reserve from
coronary CT angiography. NICE medical technology guidance, February 2017. London: NICE.
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