Rapid assessment chest pain clinics provide effective triage
A long-term follow up study has confirmed that rapid assessment clinics accurately identify low-risk patients with non-coronary pain.
The study enrolled 3,378 patients attending a staff grade-led urban rapid assessment chest pain clinic between April 1996 and February 2000. Data were available for 3,039 patients, who were followed up for a median of six years. Outcome measures included all-cause mortality, composites of coronary mortality and morbidity, and revascularisation. Coronary standardised mortality ratios (SMRs) were calculated.
The results showed that 2,036 patients (60%) were categorised as low risk, 957 (28%) as having stable coronary disease and 214 (6%) as having an acute coronary syndrome.
Only 5.5% of the low-risk group died from any cause compared with 18.2% and 18.4% in the stable disease and acute coronary syndrome groups respectively. Furthermore, only 3.6% of patients in the low-risk group died from coronary disease or had an MI, compared with 11.9% and 24.6% in the stable disease and acute coronary syndrome groups respectively.
The low-risk group had a significantly lower coronary SMR, 51 (95% CI 31-83), compared with the local population (100). By contrast, coronary SMRs were significantly greater in the stable disease and acute coronary syndrome groups, 240 (95% CI 187-308); and 780 (95% CI 509-1196) respectively.
It is now accepted practice to refer patients with suspected angina to a rapid assessment chest pain clinic for exercise testing and a more definitive diagnosis. Several studies have demonstrated the effectiveness of this approach but with a limited duration of follow-up. This study has provided further evidence that rapid assessment chest pain clinics are very effective at triaging patients with chest pain and those deemed to be at low risk appear to be appropriately reassured.
Taylor GL, Murphy NF, Berry C et al. Long-term outcome of low-risk patients attending a rapid-assessment chest pain clinic. Heart 2008:94;628-32Reviewer
Dr Peter Savill
GPwSI Cardiology, Southampton