(P054) EVALUATING THE UTILITY AND SAFETY OF A RAPID ACCESS CHEST PAIN CLINIC AT A QUATERNARY REFERRAL CENTRE

Background: Chest pain is a common Emergency Department (ED) presentation. Although most patients will have non-ischemic causes, the consequences of missing a coronary diagnosis can increase the risk of adverse events. Rapid Access Chest Pain Clinics (RACPC) provides prompt assessment to identify patients at high risk for early interventions. We aimed to characterize the safety and utility of the first RACPC in British Columbia.

METHODS AND RESULTS: Consecutive individuals presenting to the ED from September 2020, with low to intermediate risk of ischemic chest pain, were referred to the RACPC at a Quaternary Hospital. In all patients, an acute coronary syndrome was ruled out and prior to the RACPC referral, the ED physicians utilized an algorithm developed by RACPC locally to determine the optimal investigation for identifying those with an ischemic etiology. All patients were then reviewed urgently by a RACPC cardiologist following investigations. Patients with known prior obstructive coronary disease or revascularization were excluded. Patient characteristics were abstracted retrospectively from patient’s medical records. This project was approved by the UBC ethics board.

Of the n = 378 consecutive patients referred to the RACPC, n = 242 (64%) completed full RACPC assessment. The median time from ED referral to RACPC review was 3 days. The most frequent assessment designated using the algorithm was coronary computed tomography angiography (CCTA) with n = 103 (43%). Coronary artery disease, defined as any level of stenosis with CAD-RADS 1 or greater, was identified in n = 76 (31%), mainly with CCTA (89%) with a mean segment score of 1.9. Post-RACPC review, n = 13 (5%) patients were referred for outpatient invasive coronary angiography. Among fully assessed patients, n = 4 (3%) re-presented to the ED within 30 days for chest pain, while an additional n = 24 (10%) re-presented within 12 months. There were no reported myocardial infarctions, strokes, or deaths recorded.

Conclusion: The median time from ED referral to full RACPC review was short at 3 days. The need for invasive coronary angiography was low at 5%. No major cardiovascular events were reported with a low rate of repeat ED visits in the short term. The initial experience from RACPC appears to be a safe and effective pathway for assessment and management of patients with low to intermediate risk of ischemic chest pain. The RACPC is an effective and safe strategy to reduce long ED wait times and the potential to reduce health care costs.