Outcome from a rapid-assessment chest pain clinic

• Published in: QJM : An International Journal of Medicine 1998-05, Vol.91 (5), p.339-343
• Main Authors: DAVIE, A. P, CAESAR, D, CARUANA, L, CLEGG, G, SPILLER, J, CAPEWELL, S, STARKEY, I. R, SHAW, T. R. D, MCMURRAY, J. J. V
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Chest Pain - etiology; Chest Pain - therapy; Coronary Disease - diagnosis; Coronary Disease - therapy; Coronary heart disease; Female; Follow-Up Studies; Heart; Hospitals, Public; Humans; Male; Medical Audit; Medical sciences; Middle Aged; Outcome Assessment (Health Care); Pain Clinics - statistics & numerical data; Patient Satisfaction; Scotland
• ISSN: 1460-2725; 1460-2393
• DOI: 10.1093/qjmed/91.5.339

Chest pain accounts for much of the rising numbers of emergency admissions, but in-patient assessment is not necessarily the best way of dealing with these patients. We ran a 'rapid-assessment chest pain clinic' to provide an alternative route of assessment, and audited its outcome. General practitioners referred patients with recent-onset chest pain, increasing chest pain, chest pain at rest, or other chest pain of concern, on the understanding that they would be seen within 24 h. During 8 1/2 months, 334 patients were referred and 317 patients were seen, most of whom had exercise electrocardiography. A median of 6 months later, 278 patients were personally contacted to determine outcome. Of these, 18% had been admitted immediately with acute coronary syndromes, and 49% had been diagnosed as non-coronary chest pain (none of whom subsequently infarcted or died). Continuing symptoms were infrequent, and satisfaction was high, although 13% of patients had been revascularized. A significant number of patients required immediate admission and/or ultimate revascularization, but many more did not. The majority of these patients had non-coronary chest pain, and this diagnosis was substantiated by their excellent outcome and (in some cases) by further investigation.