Long-term outcome of low-risk patients attending a rapid-assessment chest pain clinic

Heart. 2008 May;94(5):628-32. doi: 10.1136/hrt.2007.125344. Epub 2007 Oct 4.

Abstract

Objective: To examine the long-term outcome of patients evaluated in a rapid assessment chest pain clinic (RACPC): are "low-risk" patients safely reassured?

Design: Retrospective cohort study.

Setting: Staff grade-led RACPC in an urban teaching hospital.

Participants: 3378 patients (51% male), attending the RACPC between April 1996 and February 2000.

Main outcome measures: Death, coronary mortality, morbidity and revascularisation over a median follow-up of 6 years. Coronary standardised mortality ratio (SMR).

Results: 2036 (60.3%) patients were categorised as "low risk", 957 (28.3%) as having "stable coronary artery disease" and 214 (6.3%) as being an "acute coronary syndrome". During the study, 3.6% of patients in the low risk category, 11.9% in the stable coronary artery disease category and 24.6% in the acute coronary syndrome category died from coronary artery disease or had a myocardial infarction. 5.5%, 18.2% and 18.4%, respectively, died from any cause. Compared to the local population (coronary SMR = 100), our "low risk/non-coronary chest pain" cohort had a coronary SMR of 51 (95% CI 31 to 83), the "stable coronary artery disease" cohort 240 (187 to 308) and the "acute coronary syndrome" cohort 780 (509 to 1196).

Conclusion: The RACPC was effective at triaging patients with chest pain. Patients identified as at "low risk" were unlikely to have an adverse coronary outcome and were appropriately reassured.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angina Pectoris / diagnosis
  • Cardiology Service, Hospital
  • Chest Pain / etiology*
  • Cohort Studies
  • Coronary Disease / diagnosis*
  • Female
  • Health Services Accessibility / standards*
  • Humans
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Prognosis
  • Referral and Consultation / standards
  • Retrospective Studies
  • Scotland
  • Survival Analysis
  • Treatment Outcome