University of Edinburgh

British Heart Foundation

DL_2023_034

Chest pain is a serious symptom that may indicate heart disease. It is a common reason for people to attend hospital or their GP. Specialist cardiac services have been designed to review those with suspicious symptoms and start important treatments if necessary. These are known as Rapid Access Chest Pain Clinics (RACPC). However, there has been no systematic review of referral patterns and outcomes after RACPC assessment. Not every patient with chest pain is referred by their GP, and not every referral is triaged to RACPC. We suspect that opportunities to prevent heart attacks may be being missed. To investigate this, we will use linked healthcare data to evaluate outcomes in patients with recent onset chest pain, over the last decade in NHS Lothian. We will review how investigations, treatments, and outcomes (such as heart attacks and deaths due to heart disease) have varied between those reviewed and not reviewed in specialist services. Our aim is to find improvement opportunities and identify the types of referrals that should be prioritised.

Recent onset chest pain can occur due to unstable or progressive narrowing of the heart arteries and patients often seek advice for this from their GP. It is common for patients to report sentinel episodes of chest pain or crescendo symptoms prior to presenting with a heart attack or sudden death in the community. Assessment in the GP’s surgery is challenging as there is limited access to objective measures of risk and diagnostic tests in this setting. Rapid Access Chest Pain Clinics are designed to assess, investigate and initiate management, but not every patient is referred and not every referral is seen. The main beneficiaries of this research will be patients with new onset chest pain who often seek advice from primary and secondary care. A systematic evaluation of the performance of current services will provide them with reassurance and help to identify areas where we can improve this assessment and care services. We will particularly look to highlight delays of care and look at how patients are currently triaged to determine if the higher risk patients are waiting longer and whether this is associated with worse outcomes. This proposal has been written by providers of the current service who do not currently have awareness of outcomes after patients are referred, particularly for those triaged to GP-only care. The development of a same day virtual assessment for patients with new onset chest pain could provide a more convenient and reliable assessment of risk. The evaluation of a pilot study will be shaped by the findings of this analysis of existing services.

Public Health Research

21/12/2023

Anonymous

Release