CARDIOVASCULAR MEDICINE

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

J N Tenkorang¹, K F Fox², T J Collier³, D A Wood²

¹ Charing Cross Hospital, London, UK
² Imperial College, London, UK
³ London School of Hygiene and Tropical Medicine, London, UK

Correspondence to:
Dr Kevin F Fox
5th Floor Lab Block, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK; k.fox{at}imperial.ac.uk

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.

Abbreviations: ACE, angiotensin converting enzyme; NICE, National Institute for Health and Clinical Excellence; ONS, Office For National Statistics; PPV, positive predictive value; RAAC, rapid access arrhythmia clinic; RACPC, rapid access chest pain clinic; RAHFC, rapid access heart failure clinic

Keywords: arrhythmia; chest pain; heart failure; rapid access clinic

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