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Rapid access arrhythmia clinic for the diagnosis and management of new arrhythmias presenting in the community: a prospective, descriptive study

¹ Cardiovascular Medicine, National Heart and Lung Division, Charing Cross Campus, Imperial College, London, UK
² Department of Cardiology, National Heart and Lung Division, Hammersmith Campus, Imperial College, London, UK
³ Department of Cardiology, National Heart and Lung Division, St Mary’s Campus, London, UK
⁴ Medical Statistics Unit, Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK

Correspondence to:
Correspondence to:
Dr K F Fox
Cardiovascular Medicine, National Heart and Lung Division, Charing Cross Campus, Imperial College, London W6 8RF, UK; k.fox{at}imperial.ac.uk

Objective: To investigate whether a rapid access approach is useful for the evaluation of patients with symptoms suggestive of a new cardiac arrhythmia.

Design: Prospective, descriptive study.

Setting: Secondary care based rapid access arrhythmia clinic in West London, UK.

Participants: Patients referred by their general practitioner or the emergency department with symptoms suggestive of a new cardiac arrhythmia.

Main outcome measures: Number of patients with a newly diagnosed significant arrhythmia. Number of patients with diagnosed atrial fibrillation. Number of eligible, moderate, and high risk patients treated with warfarin.

Results: Over a 25 month period 984 referrals were assessed. The mean age was 55 years (range 20–90 years) and 56% were women. The median time from referral to assessment was one day. A significant cardiac arrhythmia was newly diagnosed in 40% of patients referred to the RAAC. The most common arrhythmia was atrial fibrillation, with 203 new cases (21%). Of these, 74% of eligible patients over 65 were treated with warfarin. Other arrhythmias diagnosed were supraventricular tachycardias (127 (13%)), conduction disorders (43 (4%)), and non-sustained ventricular tachycardia (21 (2%)). Vasovagal syncope was diagnosed for 53 patients (5%). The most frequent diagnosis was symptomatic ventricular and supraventricular extrasystoles (355 (36%)).

Conclusion: A rapid access arrhythmia clinic is an innovative approach to the diagnosis and management of new cardiac arrhythmias in the community. It provides a rapid diagnosis, stratifies risk, and leads to prompt initiation of effective treatment for this population.

Keywords: arrhythmias; atrial fibrillation; rapid access arrhythmia clinic; warfarin