A Rapid Access Chest Pain Clinic (RACPC): Initial Australian Experience

Area of Science:

• Cardiology
• Emergency Medicine
• Health Services Research

Background:

• Chest pain is a common emergency department (ED) presentation, but most cases are not acute coronary syndrome (ACS).
• Rapid access chest pain clinics (RACPC) are proposed for prompt outpatient assessment of low-risk patients discharged from the ED.
• The study examines the effectiveness of an Australian RACPC model.

Purpose of the Study:

• To evaluate the outcomes of a cardiologist-led rapid access chest pain clinic (RACPC) in an Australian metropolitan setting.
• To assess the readmission rates for acute coronary syndrome (ACS) in patients managed through the RACPC pathway.
• To determine the safety and efficacy of this model of care for chest pain management.

Main Methods:

• 1133 consecutive patients with chest pain were reviewed at a metropolitan RACPC between August 2008 and February 2017.
• Exercise stress testing (EST) was the primary investigation, with coronary computed tomography (CT) scans also utilized.
• Patient outcomes, including revascularization and readmission rates for ACS, were tracked.

Main Results:

• The cohort had a high prevalence of cardiovascular risk factors.
• 1.6% of patients underwent revascularization, with no subsequent ACS readmissions.
• Readmission rates within 48 hours and 28 days were low (0.4% and 2.1% respectively), with no cardiovascular causes identified.

Conclusions:

• Direct ED referral for exercise testing followed by RACPC review is associated with very low readmission rates for chest pain patients.
• The model of care demonstrated safety, even with waiting times exceeding protocol.
• Further investigation into this RACPC model in Australia is recommended for chest pain management.