A Rapid Access Chest Pain Clinic (RACPC): Initial Australian Experience

Yu, Christopher; Sheriff, Javed; Ng, A.; Brazete, S.; Gullick, Janice; Brieger, David; Kritharides, Leonard; Lowe, Harry C.

doi:10.1016/j.hlc.2017.11.006

Cited by 11 publications

(24 citation statements)

References 13 publications

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“…Evaluating the RACPC model in an Australian setting has been suggested . We therefore tested the hypothesis that an RACPC would provide more efficient care and superior clinical outcomes for patients with new onset chest pain than the usual care model of cardiology outpatient clinics.…”

supporting

confidence: 86%

“…RACPC‐initiated investigations were at the discretion of the treating clinician. An alternative model, recently evaluated in an Australian hospital, includes routine exercise testing before review. The investigators reported a low rate of unplanned re‐presentations at 28 days (2.6%) and no episodes of acute coronary syndrome; however, the burden of investigation was high, with 93% of patients undergoing exercise testing, leading to additional investigations in 35% of those tested.…”

Section: Discussionmentioning

confidence: 90%

“…Our review target was determined in consultation with referring doctors, and is consistent with current Australian guidelines . In practice, review times were sometimes longer, largely because patients preferred convenience to promptness, consistent with observations in other RACPCs . The two‐week target is practicable and safe, no patient having experienced an adverse event during this period.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating the benefits of a rapid access chest pain clinic in Australia

Black

Cheng

Flood

et al. 2019

Medical Journal of Australia

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Objectives To compare the outcomes and safety of a rapid access chest pain clinic (RACPC) in Australia with those of a general cardiology clinic. Design Prospective comparison of the outcomes for patients attending an RACPC and those of historical controls. Setting Royal Hobart Hospital cardiology outpatient department. Participants 1914 patients referred for outpatient evaluation of new onset chest pain (1479 patients seen in the RACPC, 435 patients previously seen in the general cardiology clinic). Main outcome measures Service outcomes (review times, number of clinic reviews); adverse events (unplanned emergency department re‐attendances at 30 days and 12 months; major adverse cardiovascular events at 12 months, including unplanned revascularisation, acute coronary syndrome, stroke, cardiac death). Results Median time to review was shorter for RACPC than for usual care patients (12 days [IQR, 8–15 days] v 45 days [IQR, 27–89 days]). All patients seen in the RACPC received a diagnosis at the first clinic visit, but only 139 patients in the usual care group (32.0%). There were fewer unplanned emergency department re‐attendances for patients in the RACPC group at 30 days (1.6% v 4.4%) and 12 months (5.7% v 12.9%) than in the control group. Major adverse cardiovascular events were less frequent among patients evaluated in the RACPC (0.2% v 1.4%). Conclusions Patients were evaluated more efficiently in the RACPC than in a traditional cardiology clinic, and their subsequent rates of emergency department re‐attendances and adverse cardiovascular events were lower.

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supporting

confidence: 86%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Evaluating the benefits of a rapid access chest pain clinic in Australia

Black

Cheng

Flood

et al. 2019

Medical Journal of Australia

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“…Rapid-access clinics were described as models of care that prioritize rapid symptom assessment and diagnostic evaluation by specialists in an outpatient setting with the goal of reducing hospitalizations. Referrals to rapid-access clinics typically came from emergency department clinicians and outpatient GPs to evaluate to evaluate chest pain 61,[65][66][67][68] and symptoms of arrhythmia. 70 Prospective observational analyses of rapid-access clinics models demonstrated reductions in unplanned cardiovascular hospitalization and death.…”

Section: Symptom Management Care Modelsmentioning

confidence: 99%

Person-Centered Models for Cardiovascular Care: A Review of the Evidence: A Scientific Statement From the American Heart Association

Rossi¹,

Granger²,

Bruckel³

et al. 2023

Circulation

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Cardiovascular disease remains the leading cause of death and disability in the United States and globally. Disease burden continues to escalate despite technological advances associated with improved life expectancy and quality of life. As a result, longer life is associated with multiple chronic cardiovascular conditions. Clinical guidelines provide recommendations without considering prevalent scenarios of multimorbidity and health system complexities that affect practical adoption. The diversity of personal preferences, cultures, and lifestyles that make up one’s social and environmental context is often overlooked in ongoing care planning for symptom management and health behavior support, hindering adoption and compromising patient outcomes, particularly in groups at high risk. The purpose of this scientific statement was to describe the characteristics and reported outcomes in existing person-centered care delivery models for selected cardiovascular conditions. We conducted a scoping review using Ovid MEDLINE, Embase.com, Web of Science, CINAHL Complete, Cochrane Central Register of Controlled Trials through Ovid, and ClinicalTrials.gov from 2010 to 2022. A range of study designs with a defined aim to systematically evaluate care delivery models for selected cardiovascular conditions were included. Models were selected on the basis of their stated use of evidence-based guidelines, clinical decision support tools, systematic evaluation processes, and inclusion of the patient’s perspective in defining the plan of care. Findings reflected variation in methodological approach, outcome measures, and care processes used across models. Evidence to support optimal care delivery models remains limited by inconsistencies in approach, variation in reimbursement, and inability of health systems to meet the needs of patients with chronic, complex cardiovascular conditions.

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“…Data on the RACPC model of care are considerably more limited in Australia than in the UK. In two recent reports, most referrals were from emergency departments; each study found that the final diagnosis was cardiac chest pain in fewer than 10% of patients and that rates of re‐presentation to emergency departments and hospitalisation were low . One of the studies reported high satisfaction among referrers and patients, and found that 11.3% of emergency department referrers would have admitted the patient if the RACPC had not been available .…”

Section: Box Age‐standardised Hospitalisation Rates For People With Amentioning

confidence: 99%

Rapid access clinics for patients with chest pain: will they work in Australia?

Chow

2019

Medical Journal of Australia

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A Rapid Access Chest Pain Clinic (RACPC): Initial Australian Experience

Cited by 11 publications

References 13 publications

Evaluating the benefits of a rapid access chest pain clinic in Australia

Evaluating the benefits of a rapid access chest pain clinic in Australia

Person-Centered Models for Cardiovascular Care: A Review of the Evidence: A Scientific Statement From the American Heart Association

Rapid access clinics for patients with chest pain: will they work in Australia?

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