title: A nurse-led palpitations clinic: a 2-year experience.
abstract: OBJECTIVE
  To investigate the role of a nurse-led clinic in the assessment of patients with palpitations.
  
  
  METHODS
  Prospective descriptive study.
  
  
  METHODS
  Nurse-led palpitations clinic in a UK district general hospital.
  
  
  METHODS
  Patients referred from primary care or the emergency department with palpitations.
  
  
  METHODS
  Referral letters were screened, and only patients without high-risk features or a documented arrhythmia were diverted to the palpitations clinic. Patients were evaluated using a protocol. All patients had an ECG and ambulatory ECG monitoring and were discussed with a cardiologist.
  
  
  RESULTS
  Over 15 months, 389 patients were seen. The mean time from referral to assessment was 38 days (range 3-142). The most common diagnoses were symptomatic extrasystoles (42%) and sinus rhythm (22%). Significant arrhythmias were diagnosed in 15% (atrial fibrillation/flutter, 8%; supraventricular arrhythmias, 6%). Only 52 (13%) were subsequently referred to a cardiologist, including 20 with high-risk features. These 20 patients waited on average an additional 70 days to be seen by a cardiologist compared with patients who were seen directly by a cardiologist after referral by primary care or the emergency department.
  
  
  CONCLUSIONS
  For low-risk patients, a nurse-led palpitations clinic may provide a viable alternative to the traditional cardiology outpatient service. Despite attempts to exclude them, some high-risk patients were seen. This was unforeseen and led to a clinically important delay in their appropriate assessment. Hence, before adopting a nurse-led palpitations service, a rigorous pathway for the early assessment of high-risk patients needs to be agreed.
authors.affiliation: Department of Cardiology, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: P A
authors.initials: PA
authors.lastname: Scott
authors.forename: P
authors.initials: P
authors.lastname: Appleford
authors.forename: T G
authors.initials: TG
authors.lastname: Farrell
authors.forename: N P
authors.initials: NP
authors.lastname: Andrews
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000451:nursing*; D016507:Cardiology Service, Hospital / Q000458:organization & administration; D003325:Coronary Care Units / Q000458:organization & administration; D004562:Electrocardiography / Q000451:nursing; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057184:Practice Patterns, Nurses' / Q000458:organization & administration*; D012017:Referral and Consultation; D055815:Young Adult