UK radiology crisis left 56K angina patients without lifesaving scans in 2017

Critical shortages of imaging equipment and qualified radiologists left an estimated 56,000 angina patients without access to potentially lifesaving computed tomography (CT) scans last year, the Royal College of Radiologists (RCR) and British Society of Cardiovascular Imaging (BSCI) announced Nov. 8.

The research, released on the International Day of Radiology, details a shortfall in the number of CT coronary angiography (CTCA) exams administered to patients presenting with chest pain at hospitals across the U.K. While such patients are often automatically referred for an exercise test, experts in cardiology have argued physical exertion isn’t an accurate enough gauge of angina.

Instead, the National Institute for Health and Care Excellence (NICE) advises that all patients with angina-like symptoms undergo CTCA, since in recent clinical studies the scans have significantly lowered rates of myocardial infarction in patients with suspected angina.

Reviewing health records, a team from the RCR and BSCI identified the number of suspected angina patients who presented to hospitals in England, Scotland, Wales and Northern Ireland last year. Those figures suggested at least 132,080 CTCA scans should have been performed in 2017, but in reality just 75,791 tests were administered—a shortfall of 43 percent.

According to the data, provision for CTCA scans was best in England, where 69,865 CTCA exams were performed compared to the 111,239 that should have been. The disparity was worst in Wales, where a 78 percent shortfall in the minimum number of scans needed left an estimated 4,854 patients without access to a CTCA exam.

Nearly 8,000 patients are estimated to have missed out on CTCAs in Scotland last year, and 2,162 missed out in Northern Ireland. Since the total number of CTCA scans performed in 2017 covered more than just chest pain patients, the RCR and BSCI said all their estimates are conservative, with actual numbers likely to be higher.

“CTCA scans are incredibly good at detecting and ruling out heart disease, almost perfect,” BSCI President Giles Roditi said in a statement. “It is beyond frustrating that we do not have the capacity to provide what should be a routine frontline test for everyone presenting with chest pain.”

Roditi said his organization’s research also shed light on the inaccessibility of CTCAs, especially considering the dire situation in the U.K. An anonymous poll of BSCI consultants found waiting times for the exams are still as high as 26 weeks, or six months.

“In many hospitals it is easier for a runner with a dodgy knee to get a magnetic resonance scan than it is for a patient on the verge of a heart attack to get a CTCA,” Roditi said. “Deadly cases of heart disease are being missed because we can’t deliver these scans properly across the U.K.”