A rapid access cardiology service for chest pain, heart failure and arrhythmias accurately diagnoses cardiac disease and identifies patients at high risk: a prospective cohort study.
OBJECTIVE
To conduct a one year follow up study of patients seen in a combined rapid access chest pain, arrhythmia and heart failure clinic.


METHODS
Local general practitioners, accident and emergency department clinicians and other hospital clinicians were invited to refer patients with a new presentation of chest pain, palpitations and suspected cardiac-induced breathlessness to the rapid access cardiology clinics at Charing Cross Hospital, London, on a one-stop, no appointment basis. Consent to be followed up by a postal questionnaire one year later was sought from all patients attending between 1 November 2002 and 31 October 2003.


RESULTS
1223 patients were seen in the 12 month study period. 940 (77%) consented to one year follow up. 216 (23%) patients had a diagnosis of definite cardiac, 621 (66%) of not cardiac and 103 of possible cardiac disease (11%). 98% of patients diagnosed "not cardiac" did not receive a diagnosis of cardiac disease over the following 12 months. Of patients with diagnosed definite cardiac disease, one year cardiac mortality was 7 of 216 (3%), compared with an age- and sex-matched expected cardiac mortality of 0.9% (standardised mortality ratio 3.5, 95% confidence interval (CI) 1.4 to 7.2). For patients with an initial diagnosis of possible or not cardiac disease, cardiac mortality at one year was 0.3% compared with an expected cardiac mortality of 0.4% (standardised mortality ratio 0.8, 95% CI 0.1 to 2.8).


CONCLUSIONS
A rapid access cardiology clinic accurately diagnoses and risk stratifies patients into those with cardiac disease at high risk of cardiac death and those without significant cardiac disease.
Tenkorang
J N
JN
Charing Cross Hospital, London, UK.
Fox
K F
KF
Collier
T J
TJ
Wood
D A
DA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000787:Angina Pectoris / Q000175:diagnosis* / Q000401:mortality; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000401:mortality; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005080:Exercise Test; D005260:Female; D006297:Health Services Accessibility; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors