Key result
Nurse-led chest pain assessment leads to angiography in ~25% of patients, confirming CAD in most.
Why the study?
In January 2001, management of the Harefield Hospital rapid access chest pain clinic transitioned from cardiology registrars to a Cardiology Nurse Consultant. This study describes the organisation and outcomes from the first 3 years of the nurse-led clinic.
Observational (n=454)
No
A nurse-led rapid access chest pain clinic can effectively assess patients, facilitate early diagnosis of cardiac disease, and achieve high patient satisfaction.
Answers are grounded in this paper and cite their sources.
May support nurse-led chest pain clinics for triage; leaves open need for randomized outcome trials before practice change.
Background: The clinical presentation of chest pain is a major problem for primary health care professionals. Rapid access chest pain clinics (RACPC) enable quick assessment, investigation and formation of a treatment plan for such patients without a waiting list. There has been a chest pain clinic in operation at Harefield Hospital since 1988. Until 2001, the cardiology registrars were responsible for the clinic. Beginning in January 2001, the management of the clinic was taken over by the Cardiology Nurse Consultant. This paper will describe the organisation and outcomes of the first 3 years of this nurse-run RACPC. Process: Patients are seen within 2 weeks of referral in line with the National Service Framework for Coronary Heart Disease [Department of Health. National service framework for coronary heart disease. Dept of Health; 2000. London.]. An electrocardiogram (ECG) is recorded on arrival in the clinic and the Nurse Consultant then examines the patients and decides if further investigation is required. Results: Four hundred and fifty-four patients were seen in the clinic from January 2001–December 2003. Three hundred and twenty-four patients (71.4%) underwent exercise testing of which 54 (16.7%) had a positive result. One hundred and thirteen patients (24.9%) were referred for angiography. Of these, 75 (66.4%) had coronary heart disease. Thirty-three patients (29.2%) have undergone percutaneous coronary intervention (PCI) and 19 (16.8%) have required coronary artery bypass grafting (CABG). Twenty-three patients (20.4%) are being treated medically. Satisfaction with the service offered by the clinic was high, evidenced by the results of questionnaires sent to patients. Conclusion: This paper demonstrates that nurses can successfully run RACPCs without an increased risk of incorrect diagnosis. These clinics offer patients timely access to assessment of their chest pain and facilitate early diagnosis of cardiac disease. They are also well accepted by the patients attending the clinic.
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Alison Pottle (2005) conducted an observational in Chest pain / suspected coronary heart disease (n=454). Nurse-led rapid access chest pain clinic (RACPC) was evaluated on Angiography referral and diagnosis of coronary heart disease. Nurse-led rapid access chest pain clinic assessment of 454 patients resulted in exercise testing for 71.4% and angiography referral for 24.9%, of whom 66.4% had coronary heart disease.
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