The development and first six years of a nurse-led chest pain clinic

Chest pain is a common symptom that creates significant anxiety for patients until a diagnosis can be offered. However, hospital cardiology services can struggle to cope with referral demands from primary care. The aim of this paper is to describe the development and implementation of a nurse-led chest pain service, its care processes and clinical outcomes to show feasibility, safety and sustainability.

We retrospectively analysed referral, demographic, cardiovascular risk, management and clinical outcome data relating to patients assessed in the nurse-led chest pain clinic in a large metropolitan district health board.

Between January 2010 to December 2016, 3,587 patients attended the clinic, median 2.6 weeks (IQR 2-3) from referral to attendance. 1,921 (54%) were male and 2,059 (57%) were less than 60 years old. Most patients, 3,059 (85%), had an exercise tolerance test (ETT) and of those, 294 (10%) were positive, 572 (18%) non-diagnostic and 2,193 (72%) negative. Cardiovascular disease (CVD) prevention medication was added or modified for 1,150 (32%) patients, all patients who smoked were offered cessation support and all patients were provided with tailored lifestyle advice depending on their absolute CVD risk. Of the 319 (9%) referred for a diagnostic coronary angiogram, 205 (64%) had important coronary disease. The majority of patients, 2,088 (58%) were able to be discharged without any further investigation planned. Over a median follow-up period of 3.6 years, we identified 14 (0.4%) cardiac-related deaths, median (IQR) 2 (1-4) years from review to death.

The nurse-led clinic offers an enhanced prevention focus that is sustainably managing large numbers of patients with outcomes similar to international studies and within recommended local timeframes.