Rapid Access Chest Pain Clinic

Scope

The RACPC provides rapid and efficient review for patients presenting with new onset or progressive chest pain with anginal features of less than 12 week duration.

Key referral criteria summary:

  • Has the chest pain been ongoing for longer than 12weeks?
  • Has the patient previously been seen by a Cardiologist or investigated for IHD?
  • Has the patient had previous coronary angioplasty or coronary artery bypass surgery?
  • Is the patient currently under Cardiology follow-up?
  • Are palpitations the primary complaint?

An answer of YES to any of the above questions would deem RACPC referral inappropriate. Please redirect on e-referral to Cardiology.

Patients with Heart Failure, new murmurs, valvular heart disease, or a complex medical history with multiple pathologies, should be referred to Cardiology via e-Referral.

Please note pre-referral criteria may be applied to referrals for patients with this condition.

  • Referrals submitted on an incorrect proforma may be returned.

Out of Scope

Patients with prolonged or severe chest pain at rest should be referred for urgent admission

Patients with longstanding atypical chest pain should be referred to the general cardiology clinic.

Women under 40 or men under 30 years old have a very low prevalence of significant CAD and should be referred to the general cardiology clinic unless they have a good anginal history and/or very adverse risk factor profile.

Investigations

The following are mandatory to include (referrals will be returned if not included):

  • Blood pressure
  • Bloods - Hb, Creatinine and Cholesterol

Management

  1. GP refers using revised proforma
    • The revised proforma will not have exclusions, such as the inability to exercise, ECG abnormalities
    • It will only limit referrals to patients presenting with new onset or progressive chest pain with anginal features of less than 12 weeks duration.
  2. DRSS will contact the patient on the day the referral is received to offer them an appointment within 2 weeks with the Rapid Access Chest Pain Service at Derriford. Patients will receive a letter confirming their appointment date and time from Plymouth Hospitals NHS Trust
  3. History by specialist
  4. Examination by specialist
  5. The specialist will decide on appropriate management and use of available investigations as per NICE guidance, applied according to our patient population risk
    • These investigations include:
      • None required
      • Coronary CT angiogram
      • Stress CMR
      • Stress echo
      • Coronary angiography
  6. The GP will receive follow up correspondence with the results of the investigations and a revised management plan

Referral

Referral Instructions

Refer for Rapid Access Chest Pain Clinic

If the referral is not on the correct form then it maybe returned to the referrer.

Complete proforma below and attach to e-Referrals (Please could you ensure that all pages are returned including the PHNT page 3).

e-Referral Service Selection

  • Specialty: Cardiology
  • Clinic Type: Rapid Access Chest Pain Clinic (including exercise ECG)
  • Service: DRSS--Western-RACPC-Cardiology-NEW Devon CCG-99P

Referral Forms

Rapid Access Chest Pain Clinic referral form blank

Rapid Access Chest Pain Clinic - EMIS web

Rapid Access Chest Pain Clinic - microtest

Rapid Access Chest Pain Clinic - systmone

Supporting Information

Pathway Group

This guideline has been signed off by the Western Locality on behalf of NEW Devon CCG

Publication date: December 2017

 

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