Suspected angina pectoris: a rapid‐access chest pain clinic

We prospectively evaluated a rapid‐access chest pain clinic in terms of clinical diagnoses, outcomes, morbidity and mortality at 3 months follow‐up in patients, and cost‐effectiveness. All patients seen at the clinic from February 1999 to December 2000 were assessed. Referring doctors indicated the management they would have provided had the clinic been unavailable, to allow a cost‐effectiveness analysis. Overall, 709 patients were referred, 471 (66%) from General Practitioners, 212 (30%) from Accident and Emergency doctors and 26 (4%) from other sources. All had recent onset, or increasing frequency of ischaemic‐type chest pain (excluding those with suspected myocardial infarction or rest chest pain angina). Fifty‐one (7%) had acute coronary syndromes, 119 (17%) had stable ischaemic heart disease, 144 (20%) had possible ischaemic heart disease, and 395 (56%) were considered to have non‐ischaemic symptoms. Some 70% of patients were seen within 24 h. Only 57 patients (8%) were admitted. Had the clinic been unavailable, 160 patients would have been admitted. Out‐patient cardiology appointments were arranged for 116 patients (16%), and 429 patients (60%) were discharged directly. Follow‐up data at 3 months were obtained from 565/567 eligible patients (99.6%). No major cardiac events (death/myocardial infarction) occurred in those with non‐ischaemic chest pain. There were five deaths (including one due to cancer) and three patients had a myocardial infarction (event rate 1%). There were eleven readmissions for angina: six were in patients with acute coronary syndromes, and four of these six were awaiting revascularization. The estimated net saving was £58/patient. A rapid‐access chest pain clinic offers a prompt, safe and cost‐effective service in a challenging group of patients.