107 Nice 2016 stable chest pain guidelines: improved yield of severe coronary artery disease at invasive coronary angiography

Abstract

clinics' (VC). A team of Cardiologists and General Practitioners (GP) collaborated to create a VC via a web-based video link, enabling discussion of patients being considered by primary care for referral to the Cardiology clinic. All available GPs were present to enable an educational aspect to the discussion, and the aim of the VC was to: (i) identify appropriate patients requiring OP review, (ii) enable early selection of required investigations, and (iii) identify patients not requiring further assessment. We aimed to assess the safety and efficacy of this approach. Methods VC's were established between a Consultant Cardiologist and two primary care practices, and all referrals required an ECG. Each patient was presented by the referring GP, and the Consultant Cardiologist issued correspondence and coordinated any required tests and follow-up. A 13 month period of this practise was reviewed with 135 patient events screened via a cross-matched record of patients. Data was recorded for: indication for and outcome of discussion; likelihood patient would have had test or referral made without this service (as assessed by Cardiology); and whether patients discussed had a subsequent unplanned admission or cardiac assessment. Results 8/135 were excluded (duplicate; admitted prior to VC; not discussed; or re-discussed for learning). Efficacy Outcomes of the VC are summarised in table 1. The overall number of patients a GP 'would' have referred was 113 (89%), and the number that 'would' have had tests booked 98 (77%), across the two practises. This left an overall OPA post VC of 11% vs a potential 89% 'would' have been referred (100 potential appointments avoided), and an overall test rate post VC 48% vs 77% 'would' have had tests (37 potential tests avoided). Safety Unplanned Cardiology input post-VC included 1 subsequent chest pain clinic, a different issue to the original VC discussion, and 1 admission with syncope, which was the issue that was discussed in VC but with no pathology identified during admission. Conclusion We demonstrated a significant reduction in OP Cardiology appointments and hospital investigations, proving improved resource utilisation, and the associated safety data was reassuring. As a result, this service demonstrates a novel approach to technology-enabled streamlining of primary to secondary care services in a safe and efficient manner.

Efficacy of education delivery through multimedia and text messaging on the psychological parameters of patients scheduled for coronary angiography: a single-blind randomized controlled clinical trial

“…Coronary angiography is a standard and highly reliable diagnostic method that helps the physician in managing a patient with coronary artery disease [1]. Evidence shows that patients scheduled for coronary angiography often experience anxiety, stress, and depression [2,3].…”

In silico identification of common and specific signatures in coronary heart diseases

“…Patients with CHD are also susceptible to more complicated clinical problems. Currently, the diagnosis and therapy of CHD is rare and costly as compared to coronary angiography, which is the most popular clinical management option ( 7 ). CHD is one of the leading causes of death, and markedly affects the immunity of the body, making it an economic burden worldwide ( 8 , 9 ).…”