Long-Term Outcomes Following Rapid Access Chest Pain Clinic Assessment: First Australian Data

Yu, Christopher; Brazete, S.; Gullick, Janice; Garcia, Melissa; Brieger, David; Kritharides, Leonard; Naoum, Chris; Ng, A.; Lowe, Harry C.

doi:10.1016/j.hlc.2021.02.008

Cited by 2 publications

(3 citation statements)

References 13 publications

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“…Rapid access chest pain services were also successfully launched in Australia and China since 2008 12–15. The introduction of a once weekly half day nurse-led RACPC in Hobart increased the number of patients with a definitive diagnosis at the first clinic visit, reduced unplanned ED attendances and major adverse cardiovascular events in the following year, when compared with a historical control previously treated in the cardiology outpatients clinic 13…”

Section: Discussionmentioning

confidence: 99%

Impact of a rapid access chest pain clinic in Singapore to improve evaluation of new-onset chest pain

Toh

Khoo

Goh

et al. 2022

Postgraduate Medical Journal

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BackgroundChest pain (CP) accounts for 5% of emergency department (ED) visits, unplanned hospitalisations and costly admissions. Conversely, outpatient evaluation requires multiple hospital visits and longer time to complete testing. Rapid access chest pain clinics (RACPCS) are established in the UK for timely, cost-effective CP assessment. This study aims to evaluate the feasibility, safety, clinical and economic benefits of a nurse-led RACPC in a multiethnic Asian country.MethodsConsecutive CP patients referred from a polyclinic to the local general hospital were recruited. Referring physicians were left to their discretion to refer patients to the ED, RACPC (launched in April 2019) or outpatients. Patient demographics, diagnostic journey, clinical outcomes, costs, HEART (History, ECG, Age, Risk Factors, Troponin) scores and 1-year overall mortality were recorded.Results577 CP patients (median HEAR score of 2.0) were referred; 237 before the launch of RACPC. Post RACPC, fewer patients were referred to the ED (46.5% vs 73.9%, p<0.01), decreased adjusted bed days for CP, more non-invasive tests (46.8 vs 39.2 per 100 referrals, p=0.07) and fewer invasive coronary angiograms (5.6 vs 12.2 per 100 referrals, p<0.01) were performed. Time from referral to diagnosis was shortened by 90%, while requiring 66% less visits (p<0.01). System cost to evaluate CP was reduced by 20.7% and all RACPC patients were alive at 12 months.ConclusionsAn Asian nurse-led RACPC expedited specialist evaluation of CP with less visits, reduced ED attendances and invasive testing whilst saving costs. Wider implementation across Asia would significantly improve CP evaluation.

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Section: Discussionmentioning

confidence: 99%

Impact of a rapid access chest pain clinic in Singapore to improve evaluation of new-onset chest pain

Toh

Khoo

Goh

et al. 2022

Postgraduate Medical Journal

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“…Four studies reported the operating of RACCs to be safe 2,6,14,24 . Studies reported no patient mortality while awaiting follow‐up, 2,6,14 with a low number of RACC patients (1%) requiring direct admission to hospital for invasive coronary angiography and 0.5% having ACS ( n = 3; one with non‐ST‐elevation myocardial infarction and two with unstable angina) 2 .…”

Section: Safetymentioning

confidence: 99%

“…In one long term study, after adjusting for age, sex, hypertension, diabetes, smoking and dyslipidaemia, patients attending a RACC had fewer major adverse cardiovascular events at 12 months compared with a historical control (adjusted odds ratio [OR], 0.09; 95% CI, 0.02–0.46) 14 . Another study that explored differences in all‐cause mortality between a RACC cohort ( n = 1133; mean follow‐up, 6.3 years; standard deviation, 2.6 years) against an age‐ and sex‐matched general population control (people in NSW over the same study period) 24 found lower all‐cause mortality in the RACC cohort group for the patients aged 55–64 years ( n = 292; mortality rate per patient‐year 0.33 v expected mortality rate per year 0.63; relative risk [RR] of death, 0.53; P = 0.01), 65–74 years ( n = 182; 0.54 v 1.76; RR = 0.31; P < 0.001) and 75 years or older ( n = 62; 4.33 v 7.77; RR = 0.56; P < 0.001), with no differences in all‐cause mortality for patients aged 16–54 years 24 …”

Section: Safetymentioning

confidence: 99%

Rapid access chest pain clinics in Australia and New Zealand

Cho

French

Figtree

et al. 2023

Medical Journal of Australia

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Summary Chest pain is the second most common reason for adult emergency department presentations. Most patients have low or intermediate risk chest pain, which historically has led to inpatient admission for further evaluation. Rapid access chest pain clinics represent an innovative outpatient pathway for these low and intermediate risk patients, and have been shown to be safe and reduce hospital costs. Despite variations in rapid access chest pain clinic models, there are limited data to determine the most effective approach. Developing a national framework could be beneficial to provide sites with evidence, possible models, and business cases. Multicentre data analysis could enhance understanding and monitoring of the service.

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Long-Term Outcomes Following Rapid Access Chest Pain Clinic Assessment: First Australian Data

Cited by 2 publications

References 13 publications

Impact of a rapid access chest pain clinic in Singapore to improve evaluation of new-onset chest pain

Impact of a rapid access chest pain clinic in Singapore to improve evaluation of new-onset chest pain

Rapid access chest pain clinics in Australia and New Zealand

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