QJM Advance Access published online on February 14, 2006
QJM, doi:10.1093/qjmed/hcl013
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1 From the Newham University Hospital, London, UK
* To whom correspondence should be addressed. Background: The National Service Framework for coronary heart disease recommends rapid-access chest pain clinics (RACPCs) for cardiological assessment of new-onset chest pain within 2 weeks of referral. Aim: To measure the extent to which an RACPC successfully substituted for an out-patient cardiology clinic (OPCC) at a general hospital, in assessing new-onset chest pain referrals. Methods: Prospective measurement of attendance and waiting times for consecutive patients at the RACPC and OPCC, and multivariate analysis of factors associated with referral for angiography. Results: From September 2002 to August 2004, 1382 patients with chest pain attended the RACPC, and 228 patients, the OPCC. All RACPC patients were seen within 24 h of referral, except those referred on Friday afternoons, or the day before national holidays. The mean ± SD waiting time for OPCC appointments was 97 ± 43 days. Of 208 OPCC patients, 30 (14%) fulfilled the RACPC referral criterion of recent onset chest pain (<4 weeks duration) vs. 926/1382 (67%) RACPC patients. Thus the RACPC substituted for the OPCC in 926/956 (97%) new chest pain referrals. Patients from the OPCC were 3.82 (95%CI 1.85-7.90) more likely to be referred for a coronary angiogram. compared to those attending the RACPC. Discussion: The RACPC has provided efficient and effective substitution for the OPCC in the assessment of new chest pain referrals according to pre-defined referral criteria. Broadening the referral criterion of the RACPC to patients with chest pain of >4 weeks duration would result in more referrals.
Received September 22, 2005
Revised November 24, 2005
Original paper
Rapid-access chest pain clinics and the traditional cardiology out-patient clinic
N. Sekhri 1 *,
G.S. Feder 2,
C. Junghans 3,
H. Hemingway 3,
and
A.D. Timmis 2
2 From the Barts and The London Queen Mary's School of Medicine and Dentistry, London, UK
3 From the Department of Epidemiology and Public Health, UCL Medical School, London, UK
N. Sekhri, E-mail: neha.sekhri{at}newhamhealth.nhs.uk
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