Rapid access chest pain clinic

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Our rapid access chest pain clinic (RACPC) provides prompt specialist assessment for patients with chest pain that suggests angina, and for patients not currently under a cardiologist who have known ischaemic heart disease (a previous percutaneous coronary intervention — PCI, or coronary artery bypass graft — CABG) and have experienced a recent increase in symptoms of chest pain.

The RACPC service aims to see all patients for outpatient assessment within four weeks of being referred.

The service provides:

assessment for suspected angina (including diagnostic cardiac investigations)
treatment to relieve symptoms and reduce risk
information on treatment options/modifiable risk factors

Patients with suspected myocardial infarction (MI) or acute coronary syndrome should be sent directly to the emergency department (A&E).

We run clinics at different sites within our trust. Each clinic is run by cardiac specialist nurses and is supported by our clinical lead, Dr Tim Lockie, consultant cardiologist.

Please note, this is a nurse-led clinic. Patients requesting to be seen by a doctor only will need to be referred to the general cardiology clinic.

Inclusion criteria

Patients with the following conditions can be referred to the RACPC:

Patients with exertional chest pain suggestive of new onset angina within the last two months.
Pain that is suggestive of cardiac ischaemia andis accompanied by significant cardiac risk factors.
Women aged 40 and below, and men aged 30 and below, can only be referred in exceptional circumstances.
Blood pressure must be below 180 mmHg systolic and 90 mmHg diastolic.
Patients with exertional dyspnoea considered to be an angina-equivalent may be referred only if NT-pro BNP, chest X-ray and lung pathologies have been excluded (diabetic patients will be accepted).

Exclusion criteria

Patients with the following conditions cannot be accepted into the RACPC:

Patients with suspected acute MI or an unstable acute coronary syndrome should be referred directly to the emergency department.
Patients with known ischaemic heart disease (CABG/PCI/known angina) will not be accepted for RACPC but will be directed to an appropriate clinic. Please refer directly to interventional cardiology to avoid delay.
Isolated episodes of chest pain will not be accepted.
Patients previously investigated in the past five years with negative results for ischaemia or CT coronary angiography (CTCA) with non-significant coronary artery disease (CAD).
Patients with palpitations, dizziness or syncope should not be referred. Please refer to the appropriate cardiology service — eg cardiac rhythm management — and consider Holter monitor/echocardiogram in the first instance.
Patients will not be accepted for abnormal ECG findings. Please refer acute ECG changes directly to the emergency department. For other non-specific ECG changes, please complete an echocardiogram, with onward referral to the relevant team as necessary.
Patients with non-anginal sounding chest pain should not be referred for reassurance.
BP must be below 180 mmHg systolic and 90 mmHg diastolic. If symptomatic, please refer directly to the emergency department, or in the absence of symptoms, consider optimisation of antihypertensive medications or a referral to the complex hypertension clinic.
Patients on the acute coronary syndrome (ACS) pathway.