Outcome from a rapid-assessment chest pain clinic.
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.
MRC Clinical Research Initiative in Heart Failure, University of Glasgow, UK.
A P
AP
Davie
D
D
Caesar
L
L
Caruana
G
G
Clegg
J
J
Spiller
S
S
Capewell
I R
IR
Starkey
T R
TR
Shaw
J J
JJ
McMurray
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000209:etiology* / Q000628:therapy; D003327:Coronary Disease / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018710:Pain Clinics / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D012606:Scotland