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Yu C, Brazete S, Gullick J, Garcia MT, Brieger D, Kritharides L, Naoum C, Ng ACC, Lowe HC. Long-Term Outcomes Following Rapid Access Chest Pain Clinic Assessment: First Australian Data. Heart Lung Circ 2021; 30:1309-1313. [PMID: 33814303 DOI: 10.1016/j.hlc.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/21/2020] [Accepted: 02/07/2021] [Indexed: 11/15/2022]
Abstract
Australian guidelines recommend prompt evaluation of patients presenting to emergency departments with chest pain, found to be low risk for acute coronary syndromes, and cardiologist-led Rapid Access Chest Pain Clinics (RACPC) have been proposed as a model to provide such care. Initial Australian experience of RACPCs suggests excellent short-term outcomes, and that they are cost-beneficial, though little data exists examining longer-term outcomes. The present study therefore examines such longer-term outcomes to beyond 5 years following presentation to an RACPC in an Australian tertiary metropolitan centre.
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Affiliation(s)
- Chris Yu
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Susana Brazete
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Janice Gullick
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - M Tessa Garcia
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - David Brieger
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Leonard Kritharides
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Chris Naoum
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Austin C C Ng
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Harry C Lowe
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia.
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Yu C, Sheriff J, Ng A, Brazete S, Gullick J, Brieger D, Kritharides L, Lowe HC. A Rapid Access Chest Pain Clinic (RACPC): Initial Australian Experience. Heart Lung Circ 2018; 27:1376-1380. [PMID: 29655571 DOI: 10.1016/j.hlc.2017.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/01/2017] [Accepted: 11/19/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chest pain is the second most common presenting symptom to emergency departments (ED) in Australia, although up to 85% of these patients do not have an acute coronary syndrome (ACS). Cardiologist-led rapid access chest pain clinics (RACPC) have been proposed overseas to assist in the management of such patients, with prompt outpatient assessment if patients are deemed low risk and discharged from the ED. The use of RACPCs in Australia has been only recently proposed; we therefore sought to examine one such RACPC in an Australian context. METHODS AND RESULTS 1133 consecutive patients were seen at a metropolitan RACPC, between August 2008 and February 2017. There was a high preponderance of cardiovascular risk factors. Exercise stress testing (EST) was the default investigation upon discharge from ED, with a total of 1038 ESTs performed in 1113 patients (93%), with low numbers of other functional tests, and a small, but increasing number of coronary computed tomography (CT) scans performed over this period. Eighteen patients subsequently underwent revascularisation (1.6% of the total cohort), and none of these patients were readmitted at any time with an ACS between the interval of their index ED presentation to these investigations or treatments. Five (0.4%) patients represented to ED within 48hours, none due to a cardiovascular cause. A total of 24 (2.1%) patients represented between 2 and 28 days, with none of these due to an ACS. CONCLUSIONS Following ED assessment of acute chest pain as low risk-with direct ED referral for exercising testing followed by RACPC review-results in very low readmission rates at 48hours and at 28 days. Moreover, these readmissions were almost always not of cardiovascular aetiology, and occurred despite relatively longer waiting periods for both EST (8 days) and between EST and RACPC review (11 days), than the prespecified 72 to 96hours as defined by the clinic protocol. Further investigation into this model of care in Australia is suggested.
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Affiliation(s)
- Christopher Yu
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Javed Sheriff
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Austin Ng
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - Susana Brazete
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | | | - David Brieger
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - Harry C Lowe
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia.
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