RT Journal Article
SR Electronic
T1 Impact of a rapid access chest pain clinic in Singapore to improve evaluation of new-onset chest pain
JF Postgraduate Medical Journal
JO Postgrad Med J
FD The Fellowship of Postgraduate Medicine
SP postgradmedj-2021-141427
DO 10.1136/postgradmedj-2021-141427
A1 Toh, Lay Cheng
A1 Khoo, Christina
A1 Goh, Cheng Huang
A1 Choa, Gary
A1 Quek, Lit Sin
A1 Phang, Jonathan
A1 Wong, Franco
A1 Tsou, Keith
A1 Kwan, Yew Seng
A1 Kojodjojo, Pipin
YR 2022
UL http://pmj.bmj.com/content/early/2022/01/30/postgradmedj-2021-141427.abstract
AB 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.