Impact of the Implementation of a National AI Technology Programme on Cardiovascular Outcomes and the Health System, 2021-2024

Fairbairn, Timothy Andrew (2025). Impact of the Implementation of a National AI Technology Programme on Cardiovascular Outcomes and the Health System, 2021-2024. [Data Collection]. Colchester, Essex: UK Data Service. 10.5255/UKDA-SN-857706

Chest pain may be a symptom that is related to a narrowing of the heart blood vessels (coronary artery disease [CAD]). This chest pain, known as angina, can result in a reduced quality of life and, if not diagnosed and managed appropriately, could result in a heart attack. Coronary disease remains the largest cause of death in the United Kingdom today, with one death every 4 minutes. Guidelines recommend the use of tests to help diagnose and manage chest pain 'angina' patients. Coronary computed tomography angiography (CCTA) is a test that takes images of the heart blood vessels. It is the main test for patients presenting with angina, as it is excellent at saying when the heart blood vessels are normal, and can be reassuring for patients. However, when narrowing's are present CCTA lacks the ability to tell whether they are causing the patient's symptoms.
A new technology, CT-derived fractional flow reserve (FFRCT) uses the CCTA images to make a 3D model of the heart blood vessels that shows whether there is a limitation in the blood flow to the heart which is causing the symptoms. The National Institute for Health and Care Excellence (NICE) recommends the use of FFRCT in a chest pain pathway. However, use of this new technology remains limited due to funding restrictions and uncertainty as to its benefit in the NHS.
This study aims to determine the extent to which the new FFRCT technology is safe and reliable, provides a quicker time to diagnosis for the patient, reduces the need for further tests and thus represents good value to the NHS.

Data description (abstract)

In 2018, NHS England introduced a new Artificial Intelligence (AI) decision support technology into the health system in order to improve the diagnostic pathway of patients who were being investigated for suspected coronary artery disease.

The primary aim of the FISH and CHIPS study was to assess the impact of this health intervention by determining the differences in health-related events of a stable chest pain population undergoing Coronary Computed Tomography Angiography (CCTA) and Fractional Flow Reserve (FFR-CT), compared to a previous ‘standard of care’ diagnostic chest pain pathway of CCTA and non-invasive functional testing.

This is a multi-centre, retrospective, observational analytic cohort study design. The study utilised the electronic health record (EHR) data already collected by NHS England on all patients that underwent a CCTA for the assessment of coronary artery disease over a 3-year period (April 2017-April 2020). All patients were treated in accordance with the latest NICE clinical guidance (CG 95 2016). Healthcare data was used to determine clinical outcomes (heart attacks, death, cardiac death), procedures performed (invasive angiography, percutaneous stenting and surgical bypass grafting) and heart diagnostic tests up to 24 months following the index CCTA. Costs are determined from the NHS national tariff system.

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