A Rapid Access Chest Pain Clinic (RACPC): Initial Australian Experience

• Published in: Heart, lung & circulation lung & circulation, 2018-11, Vol.27 (11), p.1376-1380
• Main Authors: Yu, Christopher, Sheriff, Javed, Ng, Austin, Brazete, Susana, Gullick, Janice, Brieger, David, Kritharides, Leonard, Lowe, Harry C.
• Format: Article
• Language: English
• Subjects: Acute coronary syndrome; Chest pain; Troponin
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2017.11.006

Chest pain is the second most common presenting symptom to emergency departments (ED) in Australia, although up to 85% of these patients do not have an acute coronary syndrome (ACS). Cardiologist-led rapid access chest pain clinics (RACPC) have been proposed overseas to assist in the management of such patients, with prompt outpatient assessment if patients are deemed low risk and discharged from the ED. The use of RACPCs in Australia has been only recently proposed; we therefore sought to examine one such RACPC in an Australian context. 1133 consecutive patients were seen at a metropolitan RACPC, between August 2008 and February 2017. There was a high preponderance of cardiovascular risk factors. Exercise stress testing (EST) was the default investigation upon discharge from ED, with a total of 1038 ESTs performed in 1113 patients (93%), with low numbers of other functional tests, and a small, but increasing number of coronary computed tomography (CT) scans performed over this period. Eighteen patients subsequently underwent revascularisation (1.6% of the total cohort), and none of these patients were readmitted at any time with an ACS between the interval of their index ED presentation to these investigations or treatments. Five (0.4%) patients represented to ED within 48hours, none due to a cardiovascular cause. A total of 24 (2.1%) patients represented between 2 and 28 days, with none of these due to an ACS. Following ED assessment of acute chest pain as low risk—with direct ED referral for exercising testing followed by RACPC review—results in very low readmission rates at 48hours and at 28 days. Moreover, these readmissions were almost always not of cardiovascular aetiology, and occurred despite relatively longer waiting periods for both EST (8 days) and between EST and RACPC review (11 days), than the prespecified 72 to 96hours as defined by the clinic protocol. Further investigation into this model of care in Australia is suggested.