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

Joanna N Tenkorang ¹, Kevin F Fox ^2*, Tim J Collier ³ and David A Wood ²

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

^* To whom correspondence should be addressed. E-mail: k.fox{at}imperial.ac.uk.

Accepted 8 December 2005

Abstract

Introduction: Rapid Access chest pain clinics have become a central component at the primary / secondary care interface of cardiac services within the UK. Similar clinics for arrhythmia and heart failure are also being developed. The long term effectiveness of these clinics is not known. We conducted 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 (GPs), Accident and Emergency (A&E) department and other hospital clinicians are invited to refer patients with a new presentation of chest pain, palpitations and suspected cardiac-induced breathlessness to the Rapid Cardiology clinics at Charing Cross Hospital. Referred patients are seen on a 'one-stop, no appointment' basis, with a diagnosis given at the end of the initial consultation. Further follow up if required is arranged thereafter. Consent to be followed up via a postal questionnaire one year after attendance was sought from all patients attending between 1st November 2002 and 31st October 2003. GPs of consenting patients were sent a questionnaire enquiring about the patient's vital status, and cardiac morbidity. Data received from patients' and GP questionnaires were consolidated with data from hospital information systems, hospital data records and the Office For National Statistics.

Results: 1223 patients were seen in the 12 month study period. 940 (77%) consented to one year follow up. 216 (23%) patients were diagnosed as 'definite' cardiac disease at the end of the Rapid Access clinic assessment, 621 (66%) 'not cardiac' and 103 possible cardiac disease (11%). 98% of patients diagnosed 'not cardiac' did not have a diagnosis of cardiac disease attributed to them over the following 12 months. Of patients given a diagnosis of definite cardiac disease, one-year cardiac mortality was 7/216 (3%), compared with an age-sex matched expected cardiac mortality of 0.9% (Standardised Mortality Ratio (SMR) 3.5 (95% Confidence Interval 1.4, 7.2). For patients given an initial diagnosis of 'possible' or 'not cardiac' cardiac mortality at one-year was 0.3% compared to an age-sex matched expected cardiac mortality of 0.4% (SMR 0.8 [95% CI 0.1, 2.8]).

Conclusions: A Rapid 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.

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

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