Authors (including presenting author) :
Chan WP(1) , Chiu SH(1) , Lam SK(1) , Chan WS(1) , Chan NY(1)
Affiliation :
(1) Cardiac Team, Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
Introduction :
CAD remains a significant cause of morbidity and mortality of heart disease in Hong Kong. Chest pain, a cardinal symptom of CAD, is a common presenting symptom for referral to medical service. However, chest pain patients mostly waited for 2 years before the first general medical consultation in Princess Margaret Hospital due to profound demand on Specialist out-patient clinic service. The total episodes of medical consultation in each patient from the first consultation to case closed in usual pathway was 5.5 episodes in average. To early identify CAD patients, nurse-led chest pain clinic (CPC) was implemented in October 2022 in PMH to provide rapid access and early assessment for chest pain patients.
Objectives :
-To early identify CAD patients for early treatment -To screen out high risk case for early cardiologist access & management -To relieve demand on Specialist out-patient clinic service by reducing medical’s consultation episodes & times.
Methodology :
A retrospective cohort study design was adopted. The clinical outcomes of unselected patient who were attending CPC clinic from 31 October 2022 to 30 September 2023 were collected and analyzed.
Result & Outcome :
Total 580 patients with age from 19 to 91 attended CPC clinic during the 12-month period and 320 (55.2%) patients were female. After clinical assessment, no further investigation was required in 141 (24%) patients who were screened out as low risk patients of CAD. Among 430 (74%) patients classified as intermediate and higher probability of CAD, 195 (45.3%) patients agreed for private CTCA under well explanation from clinic nurse. 109 (25.8%) patients opted for PMH treadmill exercise test and the remaining were either refused or not fit for investigation. Till the analysis point, 111 (19.1%) patients were diagnosed as CAD. 53 patients (9%) were fast tracked for early cardiologist assessment and management. 1 patient required clinical admission for in-patient cardiac catheterization with percutaneous coronary intervention (Coro +/- PCI) after second CPC follow-up while 2 patients emergency admitted for in-patient coro +/- PCI. Among 156 patients with positive CTCA result, 37 (17%) patients were required for coro +/- PCI while 52 (24%) patients were suggested for medical treatment. Among 226 patients with first medical consultation before 29th February 2024, total episodes of medical consultation were shortened to less than two in 73 (32.3%) patients. After investigation arranged and reviewed by nurse in CPC, 9 (4%) patients defaulted the first medical follow up and 38 (17%) patients were subsequently case closed in the first medical consultation. Reasons of more than 2 episodes of medical consultation include waiting for cardiac investigation, optimize medical treatment and other medical problems. Conclusions: Rapid access and early assessment in a nurse-led CPC provide safe and effective practice to identify chest pain patients with subsequent CAD, and shorten medical consultation episodes in SOPD service.
