OBJECTIVES: Planning processes for future diagnostic requirements of cardiology departments should be based on sound clinical and financial information. Current diagnosis of CAD is usually achieved via stress electrocardiography (sECG) / invasive X-Ray coronary angiography (CA). Reliance on these two techniques alone, however, can result in delays in diagnosis and subsequent treatment. Imaging techniques such as myocardial perfusion scintigraphy (MPS), stress echocardiography and X-ray computed tomography are potentially important modalities and could be incorporated into the diagnostic strategy for CAD.A model was developed to allow planners and cardiologists to work together to develop a range of effective diagnostic strategies; that could help to optimise workload across a range of diagnostic modalities.  METHODS: A 3-module, decision-support model was developed to simulate diagnosis and management in a cohort of risk-stratified patients with suspected CAD, within a user-defined diagnostic facility. The 'diagnostic' module incorporates alternative strategies, comprising combinations of exercise ECG (ExECG), MPS, Stress Echo, multi-slice computed tomography (MSCT) and coronary angiography (CA). The 'treatment' module is a Markov model incorporating initial patient management (based upon diagnostic results) and subsequent patient experience (mortality, future myocardial infarctions (MIs) and revascularisation procedures), according to severity of disease and therapy at outset. The ‘capacity’ module defines the local diagnostic capacity for each modality and compares throughput of the selected strategies for current practice and an alternative practice format, both of which are user-defined. RESULTS: Primary outcomes include diagnostic capacity, costs, quality of life and diagnostic accuracy. Including options of MPS, stress echo and MSCT in the diagnostic strategy for patients considered low or moderate risk reduces the average cost per 1,000 patients by almost £17,000 and increases the available capacity of CA by 6.7%. CONCLUSIONS: The use of alternative diagnostic strategies is cost-effective and could optimise the use of expensive capital equipment.