Objective: Rapid-access chest pain clinics, typically run by doctors, allow the rapid assessment of suspected new-onset angina. Five years ago specialist nurse-led rapid-access chest pain clinics were established at Royal Albert Edward Infirmary. The objective of this audit was to assess safety and effectiveness of these clinics. Method: Retrospective data were collected from all patients from January 2002 to December 2006. Results: GPs referred 1464 patients. Of those, 1349 (92.14%) patients were seen within the 14-day government target. The clinic had 1417 (96.8%) patients who under went exercise testing and 234 (16%) of these were positive. Of those patients 143 (61.8%) under went cardiac catheterization. Coronary artery disease was found in 110 patients. Eighty one patients under went revascularization and 29 patients were treated medically. Conclusions: This audit demonstrates that specialist nurse–led rapid -access chest pain clinics are safe and effective. They identify patients who are more likely to have coronary artery disease, therefore allowing early medical/surgical intervention and reducing patient morbidity and mortality. The burden on doctors is reduced and government targets are met.
Background: Under normal conditions, the arterial pressure wave reflection affects the peak systolic pressure of the peripheral but not central waveform. This leads to a normal pulse pressure amplification in the peripheral vasculature. In a setting of decreased aortic compliance, it is possible for the reflected wave to affect the peak systolic pressure of the central waveform more so than in the periphery in which case the central aortic pulse pressure is greater than the peripheral pulse pressure. We hypothesized that among patients with known hypertension receiving standard medical therapy, those who demonstrated this reverse pattern in pulse pressure amplification signified a higher-risk group in regard to the prevalence of significant coronary artery disease. Methods:We reviewed 190 consecutive patients with known hypertension who were sent for cardiac catheterization for the screening of coronary artery disease and who had ejection fractions of greater than 50% and lacked any significant valvular disease. Pulse pressure in the central aorta was obtained through an intraaortic catheter connected to a pressure transducer while peripheral pulse pressure was obtained by sphygmomanometry. Pulse pressure amplification (PPA) was measured as central minus peripheral pulse pressure; normal amplification was a negative value and reverse amplification a positive value. The presence of significant coronary artery disease required at least one coronary artery stenosis greater than or equal to 70%.
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