Rapid Access Cardiology (RAC) Services Within a Large Tertiary Referral Centre-First Year in Review

Harry Klimis; M Ehsan Khan; Aravinda Thiagalingam; Monique Bartlett; Mikhail Altman; Dylan Wynne; A Robert Denniss; N Wah Cheung; Joanna Koryzna; Clara K Chow

doi:10.1016/j.hlc.2018.05.201

Rapid Access Cardiology (RAC) Services Within a Large Tertiary Referral Centre-First Year in Review

Heart Lung Circ. 2018 Nov;27(11):1381-1387. doi: 10.1016/j.hlc.2018.05.201. Epub 2018 Jun 20.

Authors

Affiliations

¹ University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia; Westmead Applied Research Centre, Westmead Clinical School, University of Sydney, NSW, Australia. Electronic address: harry.klimis@sydney.edu.au.
² Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.
³ University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, Westmead Clinical School, University of Sydney, NSW, Australia.
⁴ University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Western Sydney University, Sydney, NSW, Australia.
⁵ University of Sydney, Sydney, NSW, Australia; Western Sydney Integrated Care Program, Sydney, NSW, Australia; Department of Endocrinology, Westmead Hospital, Sydney, NSW, Australia.
⁶ Emergency Department, Westmead Hospital, Sydney, NSW, Australia.
⁷ University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia; Westmead Applied Research Centre, Westmead Clinical School, University of Sydney, NSW, Australia.

PMID: 30278913
DOI: 10.1016/j.hlc.2018.05.201

Abstract

Background: Rapid Access Cardiology (RAC) services are hospital co-located cardiologist-led outpatient clinics providing prompt assessment and management of chest pain. This service model is part of chest pain management in the United Kingdom. However, little data exists on RAC services in Australia. Our aim was to describe the introduction of RAC services to an Australian tertiary centre (utility, safety, and acceptability).

Methods: Referrals were accepted for low-intermediate risk chest pain. Referrer and patient clinical data was collected prospectively in the first year of RAC - 4 February 2015 to 4 February 2016. Data was linked to hospital presentations/admissions to identify readmissions/mortality data.

Results: Among 520 patients (55.0% male, mean age 55.2 years), 87.6% were referred from emergency and 68.4% assessed within 5 days. The final diagnosis was new coronary artery disease (CAD) in 7.9%, and 81.3% had ≥2 cardiovascular risk factors (diabetes, hyperlipidaemia, hypertension, overweight/obesity, smoker, pre-existing CAD, and chronic renal failure). On average, 0.8 cardiac tests were ordered per person. In total, 35 (6.7%) had invasive coronary angiograms, with 51.4% having obstructive CAD. Patients reported in surveys (82.8% response rate) that 93.0% "strongly agreed" RAC services were useful to the community. Referrers were also "very satisfied" with RAC (7/17) or "satisfied" (9/17). Furthermore, of 336 referrals, referrers reported without RAC they would admit the patient in 11.3% of cases. There were 4.8% (25/520) unplanned cardiovascular readmissions and 0.6% (3/520) of these were for acute coronary syndromes and no deaths.

Conclusions: Outpatient RAC services are an accepted, effective and safe pathway for management of low-intermediate risk chest pain.

Keywords: Cardiology clinic; Chest pain; Integrated care; Rapid access; Risk assessment.

Publication types

Review

MeSH terms

Coronary Artery Disease / therapy*
Humans
Referral and Consultation / organization & administration*
Tertiary Care Centers / organization & administration*