Outcome from a rapid-assessment chest pain clinic

Abstract

Chest pain accounts for much of the rising numbers of emergency admissions, but in-patient assessment is not necessarily the best way of dealing with these patients. We ran a 'rapid-assessment chest pain clinic' to provide an alternative route of assessment, and audited its outcome. General practitioners referred patients with recent-onset chest pain, increasing chest pain, chest pain at rest, or other chest pain of concern, on the understanding that they would be seen within 24 h. During 8 1/2 months, 334 patients were referred and 317 patients were seen, most of whom had exercise electrocardiography. A median of 6 months later, 278 patients were personally contacted to determine outcome. Of these, 18% had been admitted immediately with acute coronary syndromes, and 49% had been diagnosed as non-coronary chest pain (none of whom subsequently infarcted or died). Continuing symptoms were infrequent, and satisfaction was high, although 13% of patients had been revascularized. A significant number of patients required immediate admission and/or ultimate revascularization, but many more did not. The majority of these patients had non-coronary chest pain, and this diagnosis was substantiated by their excellent outcome and (in some cases) by further investigation.

Impact of applying NICE guidance for the assessment of stable chest pain in rapid access chest pain clinics in a DGH: A service evaluation

“…The differences in these characteristics between published study cohorts [2][3][4] and the general population need consideration when extrapolating these results to other UK patients. Prevalence of TyCP, ATypCP and NACP is comparable to previous studies [2,[5][6][7][8][9]. Sixty-seven percent of our patients versus 74% of the London cohort qualified for further investigation.…”

“…Transient loss of consciousness (TLOC) is prevalent among young adults and frequently has a benign prognosis. However, when associated with certain clinical profiles it may herald serious cardiac disease [1][2][3][4][5][6]. Despite this, routine assessment through questionnaires has only been routinely performed during pre-participation screening of young athletes [7][8][9].…”

Computed Tomography Coronary Angiography as Initial Work-Up for Unstable Angina Pectoris

“…However, a substantial proportion of patients in the high-risk group for CAD, either waits too long before seeking professional advice and/or face significant waiting times they do so. RACPCs were introduced in UK in 2000 and to date there is a network of over 160 RACPCs across England (16)(17)(18)25). Assessment in a RACPC, includes a detailed medical history and examination, ECG, blood tests and where indicated (in accordance with established protocols, available resources and local expertise) a non-invasive and functional studies i.e.…”

“…During the last decade, the introduction of rapid access chest pain clinics (RACPC) has significantly contributed towards improvement in CAD mortality in the UK (14)(15)(16). These specialist services provide an accelerated assessment of out-patients with stable chest pain and clinical suspicion of CAD (17)(18).…”

Normal Coronary Angiogram; Clinical Characteristics of Patients

“…9,10 This differentiation between cardiac and non-cardiac conditions presenting with chest pain is often difficult but have great importance for trearment. 11 Similarly in a some patients, Myocardial Infarction (MI) is caused by coronary Artery Disease (CAD) and thrombosis, embolism, vasospasm and smoking are believed to be the mechanisms other than atherosclerosis leading to ischemia.…”