Authors (including presenting author) :
Hui ML (1), MC Chan (1), CY Wong (1), KC Chan (1), KY Lee (1)
Affiliation :
(1) Department of Medicine, Division of Cardiology, Queen Elizabeth Hospital
Introduction :
The differential diagnoses for chest pain are heterogenous, it can be related to cardiac and non-cardiac cause. Long waiting time for SOPD appointment can result in diagnostic delay in patient with possible CAD and lead to detrimental outcome, or lengthen anxiety for those with non-cardiac chest pain.
Nurse-led Chest pain clinic was introduced in QEH in Oct 2022 to improve cardiac services by providing initial assessment and investigations such as treadmill and CT coronary angiogram for patients with suspected angina within 4-6 weeks of referral to facilitate early identification of those with CAD and fast track to cardiologist clinic if early cardiac intervention is required. Further, the clinic also provides health education and reassurance for those with benign non-cardiac chest pain to alleviate their anxiety and reduce unnecessary emergency department attendances and unplanned admission.
Objectives :
To evaluate whether current chest pain nurse clinic model meet patients’ needs and are effective and safe in picking out and treating patients with CAD.
Methodology :
Retrospective data were collected from all patients attended chest pain nurse clinic between Oct 2022 to Sep 2023. Routinely-recorded data on patient demographics, clinic attendances and investigations were collected. Additionally, unplanned admission related to cardiovascular events and emergency department attendances at 30 days after recruitment into clinic were obtained.
Result & Outcome :
Results
A total of 515 patients were included in the evaluation between Oct 2022 to Sep 2023. The mean time to referral was 37.08 days (5.3 weeks). 63 (12.2%) patients were diagnosed of minor CAD. 19 (3.7%) patients were diagnosed of severe CAD and were fast track to cardiologist clinic and referred for coronary angiography. 50.6% of patients were diagnosed with other medical problem. No patients discharged after chest pain clinic assessment died or had unplanned admission with ACS. 15.6% of patients were defaulted in first SOPD medical appointment after chest pain nurse clinic and 22.9% of patients were case closed in SOPD following initial assessment.
Patients' symptoms of angina and the quality of life were generally improved after attending the clinic, as evidenced by overall score improvement in Seattle Angina Questionnaire, which including physical limitation (+4.67, p=0,00), symptom stability (+16.44, p=0.00), symptom frequency (+8.87, p =0.00), treatment satisfaction (+5.71, p=0,00) and QoL (+10.92, p=0.00).
Overall satisfaction rate of the clinic was high with 95% returned service satisfaction questionnaires showed overall satisfaction score >/= 8 (mean 8.92). No negative comments have been received.
Conclusion
This service evaluation demonstrates that chest pain nurse clinic is safe and effective in providing timely assessment to risk stratified patients without increased risk of inappropriate diagnosis and significant cardiac events, which is in line with other published literature on nurse-led chest pain clinic outcomes. Further, the targets to shorten SOPD waiting time are met and the clinic are well accepted by the patients.
