Evaluation of a Rapid Access Chest Pain Clinic Service and the Role of Coronary Anatomical and Functional Imaging

Abstract

Introduction Rapid Access Chest Pain Clinics (RACPC) provide quick and early specialist Cardiology assessment. We analysed the referrals to our RACPC to evaluate the diagnostic pathway and assess adherence to national guidelines in the management of patients with new-onset stable chest pain. Methods Retrospective data was collected from patients referred to the RACPC from the community or emergency department over a one-year period between 1st January - 31st December 2017, inclusive. Data gathered included clinical diagnosis, findings following diagnostic testing (non-invasive investigations and invasive investigations) and management. Results A total of 1,225 patients were referred, from which 1,140 attended and had evaluable data. Twenty three percent were diagnosed with atypical angina, 5.7% with stable anginal chest pain and 0.3% with unstable angina. Computerised tomography coronary angiography was performed in 27.5%, of whom 34.8% went on to have invasive angiography. Cardiovascular magnetic resonance imaging was performed in 2.9 % of cases, with only 1 patient requiring invasive angiography thereafter. Conclusion The RACPC was found to adhere to the national guidance. The majority of referrals did not require further cardiac investigations. All patients requiring cardiac investigations initially underwent non-invasive testing. Invasive angiography was performed in only a small proportion of patients attending to RACPC.