Myocardial fibrosis in hypertensive heart disease remains an area of intensive research. Whereas recent work has expanded our knowledge of the underlying processes in the development of this fibrosis, additional scientific and clinical research is required to assist clinical risk assessment and to provide evidence that therapeutic intervention confers improved clinical outcome in hypertensive heart disease.

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Rapid access chest pain clinics are expanding across the country with marked resource implications despite a paucity of data regarding their efficacy. Early assessment of patients in this manner potentially delays review of patients referred via the traditional route. We conducted a prospective observational study of patients referred with chest pain to the Cardiology Outpatient Department over a four-week period in a District General Hospital to compare demographics and outcomes in patients referred to the rapid access with those referred to the general cardiology clinics. There were no significant differences in baseline demographics, exercise test result or clinic outcome. Both populations were low risk. Discussion is needed between primary and secondary care to achieve a consensus as to the purpose of a rapid access system and how best to utilise the service appropriately. Further studies are required to assess the efficacy and health economics of this system.

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