Suspected angina pectoris: a rapid-access chest pain clinic.
We prospectively evaluated a rapid-access chest pain clinic in terms of clinical diagnoses, outcomes, morbidity and mortality at 3 months follow-up in patients, and cost-effectiveness. All patients seen at the clinic from February 1999 to December 2000 were assessed. Referring doctors indicated the management they would have provided had the clinic been unavailable, to allow a cost-effectiveness analysis. Overall, 709 patients were referred, 471 (66%) from General Practitioners, 212 (30%) from Accident and Emergency doctors and 26 (4%) from other sources. All had recent onset, or increasing frequency of ischaemic-type chest pain (excluding those with suspected myocardial infarction or rest chest pain angina). Fifty-one (7%) had acute coronary syndromes, 119 (17%) had stable ischaemic heart disease, 144 (20%) had possible ischaemic heart disease, and 395 (56%) were considered to have non-ischaemic symptoms. Some 70% of patients were seen within 24 h. Only 57 patients (8%) were admitted. Had the clinic been unavailable, 160 patients would have been admitted. Out-patient cardiology appointments were arranged for 116 patients (16%), and 429 patients (60%) were discharged directly. Follow-up data at 3 months were obtained from 565/567 eligible patients (99.6%). No major cardiac events (death/myocardial infarction) occurred in those with non-ischaemic chest pain. There were five deaths (including one due to cancer) and three patients had a myocardial infarction (event rate 1%). There were eleven readmissions for angina: six were in patients with acute coronary syndromes, and four of these six were awaiting revascularization. The estimated net saving was pound 58/patient. A rapid-access chest pain clinic offers a prompt, safe and cost-effective service in a challenging group of patients.
Dougan
J P
JP
Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, UK.
Mathew
T P
TP
Riddell
J W
JW
Spence
M S
MS
McGlinchey
P G
PG
Nesbitt
G S
GS
Smye
M
M
Menown
I B
IB
Adgey
A A
AA
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000553:Ambulatory Care / Q000458:organization & administration*; D000787:Angina Pectoris / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D003362:Cost-Benefit Analysis; D003937:Diagnosis, Differential; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration; D018710:Pain Clinics / Q000458:organization & administration*; D019095:Point-of-Care Systems; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration*; D016896:Treatment Outcome