155 Evaluation of the Rapid Access Chest Pain Clinic Service

Introduction Rapid access chest pain clinics (RACPC) evolved to urgently assess and manage patients with recent onset chest pain of cardiac origin. In 2010, NICE guidance transformed our assessment of recent onset chest pain with subsequent increase use of resource. We therefore sought to evaluate our contemporary RACPC service as part of plans to develop and improve our service. Methods A retrospective cohort analysis of patients attending RACPC was performed over a 6-month period (01/10/2013 to 31/03/2014). Data pertaining to the patient episode including baseline demographics, referral source, waiting time, chest pain description, cardiovascular risk factors, subsequent investigations and patient disposal were collated from patient medical records. Patients with pre-existing ischaemic heart disease (IHD) were excluded from further analysis. Primary endpoints include final diagnosis of coronary artery disease (CAD), all-cause mortality and subsequent hospitalisation with chest pain. Statistical analyses were performed using StatView for Windows Version 5.0 and 95% confidence intervals were taken as statistically significant in all analyses. Results In the 6-month period, 625 patients attended RACPC with 57 (9.1%) excluded as they had a pre-existing diagnosis of IHD. Most patients were referred from primary care (PC) (82.9%). The mean time to referral was 12.5 days (s.d = 8.0) with 91% seen within 14 days. Mean age was 58.0 years (s.d. = 12.6) and 51.1% were male. No significant difference in age (years) (58.2 ± 12.6 vs 56.7 ± 12.5, p = 0 .2802), gender (male) (51.2% vs 50.5%, p = 0 .9068) or risk factors (smoking (19.8% vs 25.9%, p = 0 .3944), diabetes (14.6% vs 19.3%, p = 0 .2682), hypertension (34.6% vs 28.7%, p = 0 .2827), hyperlipidaemia (20.0% vs 24.7%, p = 0 .3222) and family history (39.2% vs 31.1%, p = 0 .1454)) were observed between PC or Accident and Emergency (A&E) referrals. Referrals from A&E compared to PC were more likely declared non-cardiac chest pain (40.2% vs 24.4%, p = 0 .0006), discharged after first review (40.2% vs 24.0%, p = 0 .0010) and had fewer investigations ordered (67.0% vs 83.9%, p = p = 0 .1865). Crude all-cause mortality was 0.9% and hospitalisation with chest pain was 4.4%. No adverse outcome was observed in patients referred from A&E. Conclusion Our current RACPC service provides low diagnostic yield of CAD (10.7%) and adverse outcomes are otherwise small. This is particularly apparent in patients referred from A&E, possibly explained by differences in chest pain presentation. This data has implications for our future RACPC service suggesting improved triage of patients’ may improve the efficiency and cost-effectiveness of the service.