A 'same day' direct-access chest pain clinic: improved management and reduced hospitalization

QJM. 1998 May;91(5):333-7. doi: 10.1093/qjmed/91.5.333.


The aims of the Chest Pain Clinic were: to establish rapid-access, 'same-day', referral and attendance without a waiting list; to provide a diagnosis, treatment and follow-up plan for each patient; and to optimize the use of hospitalization for appropriate patients. Prospective data were collected from 1001 consecutive General Practitioner referrals to the Chest Pain Clinic over a 22-month period. Hospital admissions were reduced from an estimated 268 to 145 patients. Without a Chest Pain Clinic service, 213 (21%) would have been admitted inappropriately, and 89 (9%) with unstable angina or myocardial infarction would potentially have been managed in the community. A firm diagnosis was provided in 92% of cases (919 patients) with 42% (418) diagnosed as having ischaemic heart disease. The provision of a Chest Pain Clinic reduces the hospitalization of patients with benign non-cardiac chest pain whilst facilitating the identification of those patients with acute coronary syndromes requiring in-patient care. The Chest Pain Clinic service has a higher diagnostic yield for ischaemic heart disease than open access exercise electrocardiography, provides the General Practitioner with a firm clinical diagnosis in over 90% of cases, and identifies those patients requiring further treatment and invasive investigation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Chest Pain* / diagnosis
  • Chest Pain* / etiology
  • Chest Pain* / therapy
  • Female
  • Health Services Accessibility*
  • Hospitalization*
  • Hospitals, Public
  • Humans
  • Male
  • Middle Aged
  • Myocardial Ischemia / diagnosis
  • Pain Clinics / standards
  • Pain Clinics / statistics & numerical data*
  • Prospective Studies
  • Scotland
  • Utilization Review