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Impact of a rapid access chest pain clinic in Singapore to improve evaluation of new-onset chest pain
  1. Lay Cheng Toh1,
  2. Christina Khoo1,
  3. Cheng Huang Goh1,
  4. Gary Choa2,
  5. Lit Sin Quek2,
  6. Jonathan Phang3,
  7. Franco Wong3,
  8. Keith Tsou3,
  9. Yew Seng Kwan3,
  10. Pipin Kojodjojo4
  1. 1Cardiology, Ng Teng Fong General Hospital, Singapore
  2. 2Emergency Medicine, Ng Teng Fong General Hospital, Singapore
  3. 3National University Polyclinics, National University Health System, Singapore
  4. 4Cardiology, National University Heart Centre, Singapore
  1. Correspondence to Dr Pipin Kojodjojo, Cardiology, National University Heart Centre, Singapore, Singapore; pipin_kojodjojo{at}nuhs.edu.sg

Abstract

Background Chest pain (CP) accounts for 5% of emergency department (ED) visits, unplanned hospitalisations and costly admissions. Conversely, outpatient evaluation requires multiple hospital visits and longer time to complete testing. Rapid access chest pain clinics (RACPCS) are established in the UK for timely, cost-effective CP assessment. This study aims to evaluate the feasibility, safety, clinical and economic benefits of a nurse-led RACPC in a multiethnic Asian country.

Methods Consecutive CP patients referred from a polyclinic to the local general hospital were recruited. Referring physicians were left to their discretion to refer patients to the ED, RACPC (launched in April 2019) or outpatients. Patient demographics, diagnostic journey, clinical outcomes, costs, HEART (History, ECG, Age, Risk Factors, Troponin) scores and 1-year overall mortality were recorded.

Results 577 CP patients (median HEAR score of 2.0) were referred; 237 before the launch of RACPC. Post RACPC, fewer patients were referred to the ED (46.5% vs 73.9%, p<0.01), decreased adjusted bed days for CP, more non-invasive tests (46.8 vs 39.2 per 100 referrals, p=0.07) and fewer invasive coronary angiograms (5.6 vs 12.2 per 100 referrals, p<0.01) were performed. Time from referral to diagnosis was shortened by 90%, while requiring 66% less visits (p<0.01). System cost to evaluate CP was reduced by 20.7% and all RACPC patients were alive at 12 months.

Conclusions An Asian nurse-led RACPC expedited specialist evaluation of CP with less visits, reduced ED attendances and invasive testing whilst saving costs. Wider implementation across Asia would significantly improve CP evaluation.

  • ischaemic heart disease
  • accident & emergency medicine
  • organisation of health services
  • quality in health care
  • primary care

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Footnotes

  • Contributors All authors made substantial contributions to the conception and preplanning of the project. LCT, CK and PK acquired, analysed and interpreted the data. PK drafted the manuscript. All authors then revised the manuscript critically, approved the final version for submission and agreed to be accountable for the accuracy of the work reported in this manuscript. PK submitted the manuscript. PK is the guarantor for the overall contents.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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