title: Rapid-access cardiology services: can these reduce the burden of acute chest pain on Australian and New Zealand health services?
abstract: Chest pain is common and places a significant burden on hospital resources. Many patients with undifferentiated low- to intermediate-risk chest pain are admitted to hospital. Rapid-access cardiology (RAC) services are hospital co-located, cardiologist-led outpatient clinics that provide rapid assessment and immediate management but not long-term management. This service model is described as part of chest pain management and the National Service Framework for coronary heart disease in the United Kingdom (UK). We review the evidence on the effectiveness, safety and acceptability of RAC services. Our review finds that early assessment in RAC outpatient services of patients with suspected angina, without high-risk features suspicious of an acute coronary syndrome, is safe, can reduce hospitalisations, is cost effective and has good medical practitioner and patient acceptability. However, the literature is limited in that the evaluation of this model of care has been only in the UK. It is potentially suited to other settings and needs further evaluation in other settings to assess its utility.
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.|Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.|The George Institute for Global Health, Sydney, New South Wales, Australia.
authors.forename: Harry
authors.initials: H
authors.lastname: Klimis
authors.affiliation: Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Aravinda
authors.initials: A
authors.lastname: Thiagalingam
authors.affiliation: Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Altman
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.|The George Institute for Global Health, Sydney, New South Wales, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Atkins
authors.affiliation: Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia.|North Shore Heart Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Gemma
authors.initials: G
authors.lastname: Figtree
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.|Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
authors.forename: Harry
authors.initials: H
authors.lastname: Lowe
authors.affiliation: Western Sydney Integrated Care Program, Sydney, New South Wales, Australia.|Department of Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Ngai Wah
authors.initials: NW
authors.lastname: Cheung
authors.affiliation: Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Pramesh
authors.initials: P
authors.lastname: Kovoor
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.|Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.|Western Sydney University, Sydney, New South Wales, Australia.
authors.forename: Alan Robert
authors.initials: AR
authors.lastname: Denniss
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.|Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.|The George Institute for Global Health, Sydney, New South Wales, Australia.
authors.forename: Clara K
authors.initials: CK
authors.lastname: Chow
mesh_terms: D000208:Acute Disease; D001315:Australia / Q000453:epidemiology; D016507:Cardiology Service, Hospital / Q000592:standards*; D002637:Chest Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D017281:Cost of Illness; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D009520:New Zealand / Q000453:epidemiology; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D061665:Time-to-Treatment / Q000592:standards*
keywords: cardiology clinic; chest pain; integrated care; rapid access