A 'same day' direct-access chest pain clinic: improved management and reduced hospitalization.
The aims of the Chest Pain Clinic were: to establish rapid-access, 'same-day', referral and attendance without a waiting list; to provide a diagnosis, treatment and follow-up plan for each patient; and to optimize the use of hospitalization for appropriate patients. Prospective data were collected from 1001 consecutive General Practitioner referrals to the Chest Pain Clinic over a 22-month period. Hospital admissions were reduced from an estimated 268 to 145 patients. Without a Chest Pain Clinic service, 213 (21%) would have been admitted inappropriately, and 89 (9%) with unstable angina or myocardial infarction would potentially have been managed in the community. A firm diagnosis was provided in 92% of cases (919 patients) with 42% (418) diagnosed as having ischaemic heart disease. The provision of a Chest Pain Clinic reduces the hospitalization of patients with benign non-cardiac chest pain whilst facilitating the identification of those patients with acute coronary syndromes requiring in-patient care. The Chest Pain Clinic service has a higher diagnostic yield for ischaemic heart disease than open access exercise electrocardiography, provides the General Practitioner with a firm clinical diagnosis in over 90% of cases, and identifies those patients requiring further treatment and invasive investigation.
Department of Cardiology, Royal Infirmary, Edinburgh, UK. d.e.newby@ed.ac.uk
D E
DE
Newby
K A
KA
Fox
L L
LL
Flint
N A
NA
Boon
D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility; D006760:Hospitalization; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis; D018710:Pain Clinics / Q000592:standards / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012606:Scotland; D014600:Utilization Review