Ischaemic heart disease

Rapid access cardiology clinics show potential for chest pain patients

Rapid access cardiology outpatient clinics are an acceptable alternative pathway for patients with low-intermediate risk chest pain and can reduce hospitalisations, results from a NSW pilot scheme suggest.

The model, in which patients are referred to a hospital co-located cardiologist-led clinic has become the model of choice  for assessment of suspected angina in the UK.

Now researchers say it is a feasible option for Australia, after analysing the results from the first year of a rapid access clinic operating in western Sydney.

The clinic opened at a tertiary centre in February 2015 to offer rapid specialist review by a cardiology team for patients with low-to-intermediate risk chest pain of suspected cardiac origin.

Referrals were accepted from emergency departments, hospital specialists and GPs in the Western Sydney Local Health District. It operated weekday mornings and saw around eight patients per day.

A review of outcomes for 520 patients referred to the service found they were seen quickly, with a median wait time of four days.

Final diagnosis was new coronary artery disease (CAD) in 8% of patients, pre-existing CAD in 13%, and no CAD in 82%.

Six patients (1%) were directly admitted from the clinic for coronary angiography, of whom three were diagnosed with ACS. In addition, there were 25 unplanned cardiovascular readmissions over a 12-month follow up period (4.8%), with three patients were diagnosed with unstable angina or NSTEMI (rate of major adverse cardiac events was 0.6%). All cause mortality was 0%

In comparison, the unplanned cardiac readmission rate in the same area the previous was 11% with ACS the reason for readmission in 1.7% of these and 1.9% rate of all-cause mortality at 12 months.

For the area covered by the rapid access cardiology clinic, chest pain admissions fell by 2.3% from 6173 to 5915 in the year after it started operating.

The model offered “judicious” use of cardiac tests, an average 0.8 tests ordered per patient. The most common were exercise stress tests (34%) and coronary angiography (27%).

Writing in Heart Lung and Circulation, study authors led by Dr Harry Klimis, clinical lecturer at the University of Sydney’s Central Clinical School, said referrals to the clinic appeared to be appropriate, and it was well-accepted by referrers and patients.

“The analyses here indicate a lower rate of readmissions compared to the previous year and more avoidance of hospitalisation at the time of index presentation,” they noted.

“Furthermore, our study demonstrated a low MACE rate with no deaths.”

But further evaluation is needed before concluding that  rapid access cardiology clinics will decrease hospital admission rates, they said.

They also noted that many patients referred to the clinics who were not diagnosed with CAD had uncontrolled modifiable risk factors, showing potential for introducing prevention services to the clinic.

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