7 Implementation and audit
7.1 NHS hospitals and all clinicians who care for people with CAD should review current diagnostic options available to take account of the guidance set out in Section 1.
7.2 Local guidelines or care pathways for people with CAD should incorporate the guidance.
7.3 To measure compliance locally with the guidance, the following criteria could be used. Further details on suggestions for audit are presented in Appendix C.
7.3.1 MPS using SPECT is carried out for the diagnosis of individuals with suspected CAD in the following circumstances.
As the initial diagnostic tool for an individual with suspected CAD for whom sECG poses problems of poor sensitivity or difficulties in interpretation, and for an individual for whom treadmill exercise is difficult or impossible.
As part of an investigational strategy for the diagnosis of suspected CAD in an individual who has a lower likelihood of CAD and of future cardiac events.
7.3.2 MPS using SPECT is carried out as part of an investigational strategy in the management of established CAD in an individual who remains symptomatic following myocardial infarction or reperfusion interventions (CABG or PCI).
7.4 Local clinical audits on the care of patients with CAD could also include criteria for the management of CAD based on the national standards, including standards in the National Service Framework.