Key result
Nurse-led chest pain pathway safely discharges ~79% of low-risk patients after initial assessment.
Why the study?
The 2024 ESC guidelines on Chronic Coronary Syndrome recommend a low-risk chest pain assessment pathway to streamline patient flow, reduce hospital admissions, and minimise outpatient clinic workload while maintaining clinical safety. This study evaluated the effectiveness of implementing a nurse-led low-risk chest pain pathway in a busy district general hospital.
Does a Cardiology Advanced Nurse Practitioner-led low-risk chest pain pathway based on 2024 ESC guidelines effectively manage and streamline care for patients presenting with chest pain to a district general hospital Emergency Department?
Observational (n=316)
No
Does a Cardiology Advanced Nurse Practitioner-led low-risk chest pain pathway based on 2024 ESC guidelines effectively manage and streamline care for patients presenting with chest pain to a district general hospital Emergency Department?
Implementing a 2024 ESC guideline-based, nurse-led low-risk chest pain pathway in a district general hospital allowed 78.6% of eligible patients to be discharged to primary care after a single visit, reducing demand on outpatient and inpatient services.
Supports ANP-led discharge for most low-risk patients; extends ESC CCS pathway but leaves open need for prospective validation.
Background The 2024 European Society of Cardiology (ESC) guidelines on Chronic Coronary Syndrome (CCS) recommend low risk chest pain assessment pathway. This can help to streamline patient flow, reduce hospital admissions, and minimise outpatient clinic workload while maintaining clinical safety. Aim To evaluate the effectiveness of 2024 ESC guidelines on CCS by nurse led low risk chest pain pathway within the cardiology department of a busy district general hospital Methods A retrospective review was conducted of patients presenting with chest pain to the Emergency Department of a district general hospital, between October 2024 and October 2025. Of 316 patients referred for pathway consideration, criteria eligible individuals were assessed by a team of Cardiology Advanced Nurse Practitioners (ANPs) through clinical evaluation and followed by targeted investigations, including treadmill exercise tolerance testing (ETT), transthoracic echocardiogram (TTE), computed tomography coronary angiography (CTCA), invasive coronary angiography (ICA), Dobutamine Stress echocardiography (DSE) or nuclear myocardial perfusion study (NMPS), when indicated. Results Of the 316 referred patients, 88.2% met the pathway eligibility criteria. The mean age of the patients was 59 years. 53% were women and 47% were men. Following the first visit for ANP assessment, 22.1% did not require any cardiac investigations as they met very low pretest probability for obstructive CAD and 78.6% were fit for discharge to primary care with lifestyle and risk factor modification advice combined with disease-modifying and if necessary anti-anginal medications for the management of CCS. ETT was the most frequently used initial investigation (71%), with most performed on the same day of first ANP assessment. 4.3% of eligible patients needed TTE. 22% patients needed added cardiac investigations after their first ANP visit. Overall, 17% patients underwent coronary angiographic assessment (77% of these angiography assessments were CTCA and 23% had ICA). 3.2% of total patients assessed in this pathway (as 19% of patients who had coronary angiography) needed revascularisation procedure. 78% of these revascularisation procedures were percutaneous coronary interventions and 22% were coronary artery bypass grafts and required further Consultant led clinic follow up. Conclusion The Cardiology Nurse led low risk chest pain pathway reduced demand on outpatient services and inpatient beds while maintaining patient safety. These findings support the continued use of the 2024 ESC guidelines for the management of chronic coronary syndrome.
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Nekkare et al. (2026) conducted an observational in Low-risk chest pain / Suspected Chronic Coronary Syndrome (n=316). Cardiology Advanced Nurse Practitioner-led low-risk chest pain assessment pathway was evaluated on Fitness for discharge to primary care after first ANP assessment. The nurse-led low-risk chest pain pathway allowed 78.6% of eligible patients to be discharged to primary care after initial assessment, with 3.2% requiring coronary revascularization.
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