title: Pattern and outcome of subsidised referrals to cardiology specialist outpatient clinics.
abstract: BACKGROUND
  Increasing demand for public healthcare and access to specialist care has become a major concern. Characterising the referral pattern to a national centre's cardiology specialist outpatient clinics (SOCs) and the diagnostic outcomes may be useful in formulating referral guidelines to contain rising demand.
  
  
  METHODS
  A prospective observational followup study was conducted of all consecutive new patient referrals to the cardiology SOCs of the National Heart Centre over a 1-month period. The records of these 1224 patients were reviewed following their first visit and again after 3 months of evaluation and investigation. Patients' demographics, referral sources, indications of referral, risk factors, provisional and final diagnoses were collected. Referrals from the top 2 volume sources (government polyclinics and hospital Emergency Department) accounted for 600 referrals. These subsidised referrals formed the study group for analysis.
  
  
  RESULTS
  The mean age of referred patients was 56 +/- 15.2 years, with equal proportion of males and females. Most patients had known cardiac risk factors of hypertension (53.2%) and hyperlipidaemia (42.3%). Only 23% of referrals had significant cardiac abnormalities. Referrals for typical chest pain derived the highest yield whereas referrals for atypical chest pain, non-cardiac chest pain derived the lowest yield. Referrals for asymptomatic electrocardiogram (ECG) changes (except for atrial flutter/fibrillation) did not yield cardiac abnormalities. Multivariate analysis of chest pain referrals showed typical chest pain and hyperlipidaemia to be statistically significant predictors for coronary artery disease.
  
  
  CONCLUSIONS
  Referrals to cardiology outpatient specialist clinics should be based on the presence of patient symptoms, particularly that of typical chest pain. In asymptomatic patients, routine ECG screening did not appear to yield significant cardiac abnormalities.
authors.affiliation: Department of Cardiology, National Heart Centre, Singapore. Bernard.kwok.w.k@nhc.com.sg
authors.forename: Bernard W K
authors.initials: BW
authors.lastname: Kwok
authors.forename: Hak Chiaw
authors.initials: HC
authors.lastname: Tang
authors.forename: Shiou Liang
authors.initials: SL
authors.lastname: Wee
authors.forename: Virginia U M
authors.initials: VU
authors.lastname: Tai
authors.forename: Caren G P
authors.initials: CG
authors.lastname: Tan
authors.forename: Terrance S J
authors.initials: TS
authors.lastname: Chua
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D002309:Cardiology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008511:Medicine; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data*; D012846:Singapore; D013038:Specialization