Sex-based inequalities in contemporary UK hospital management of stable chest pain.

The National Institute for Health and Care Excellence (NICE) in the UK is the designated body that recommends evidence-based guidelines to ensure quality care. It also identifies priority areas for improvement in the health system and care. In 2021, NICE updated its pathway for chest pain emphasising the role of cardiac CT (CCT) as a first-line investigation followed by non-invasive functional testing prompting invasive angiography when indicated. The updated version included a statement on the utility of fractional flow reserve (FFR)-CT in the evaluation of stable chest pain and its potential cost effectiveness based on data generated by the PLATFORM Quality of life and Economic Outcomes and FORECAST FFR-CT trials.1–4 The purpose of such a streamlined pathway is to eventually offer intensive risk modification for these stable patients and fast track those who require invasive angiography based on anatomic stratification by CCT or ischaemia documented by functional tests. Morgan-Hughes et al 5 provide us with a robust prospective analysis of real-world practices in eight centres in the UK between 2018 …