The Rapid Access Chest Pain Service is for patients with new onset chest pain suggestive of angina who have not been previously assessed or for patients with previous stable angina, >5yrs duration, with recurrent or worsening angina symptoms over a 1 -4 week period. The main purpose of the RACPC is to identify patients with new or unstable angina who may benefit from urgent investigations and treatment. Consequently, referral criteria are set with this in mind.
If there is a possibility of myocardial infarction patients should be referred to A & E for urgent assessment. This includes angina symptoms that:
- Are increasing in severity
- Have increased in frequency in recent days
- Have prolonged rest pain > 20 minutes within last 12 hours
- Have had prolonged ischaemic chest pain at rest.
Patients with a diagnosis of ischaemic heart disease who have been reviewed within the last 5 years should be referred back to their named consultant or to general cardiology.
All other Cardiology patients, including complex Cardiology patients, should be referred to their previous consultant. If you have concerns about a patient and need advice, please contact the Consultant Cardiologist via their secretary. New patients with complex medical backgrounds should be referred to General Cardiology.
Where a patient is unlikely to be a candidate for invasive investigation (e.g. frailty, very elderly, extensive co-morbidity) a realistic approach offering a trial of medication (anti-angina) therapy with onward referral to Cardiology should symptoms persist is entirely reasonable.
All referrals are electronically triaged by a Consultant Cardiologist who will determine the urgency of the request, including referral to the RACP service if appropriate.
The clinic operates over 3 Lothian sites available Monday to Thursday. The service aims to see all patients within 10 working days of referral with cross-site referral occasionally being required to meet this target.
| Hospital Site | Location | Phone Number |
|---|---|---|
| The Royal Infirmary of Edinburgh | OPD3 Ground Floor | Sci-Gateway referral only |
| The Western General Hospital | ECG department Ann Ferguson Building | Sci-Gateway referral only |
| St John’s Hospital, Livingston | OPD4 | Sci-Gateway referral only |
Patients will be seen by a dedicated team of Cardiology Advanced Nurse Practioners.
The clinic will provide a “one stop shop” service where a detailed history, clinical examination including an exercise tolerance test will be performed, if required, to confirm or exclude ischaemic heart disease and to facilitate risk stratification. Patients may be referred for other diagnostic tests including a CT coronary angiogram, myocardial perfusion scan or coronary angiogram.
Prior to attending the clinic, initial investigations should include an ECG (where possible) haemoglobin, blood glucose, lipid profile, renal, liver and thyroid function. Referral should not be delayed whilst waiting for the results of blood tests. It is essential that you also provide a recent pulse, blood pressure and heart sounds. The results and this valuable information will be used to triage, assess and manage patient when seen at RACPC.
C.W & A.P 12-05-23
How to refer:
See referral flow chart and check the Indications for Referral and Exclusion Criteria below.
Please note a patient telephone number is required and RACPC will only accept referrals where all indications are marked “YES” and all exclusions are marked “NO”.
Please send electronic referral via SCI gateway to the relevant hospital (Site based on patient location – RIE, WGH or SJH) > Rapid Access Chest Pain Clinic > Rapid Access Chest Pain Clinic.
Indications
- Patients presenting with new or recent onset of exertional chest pain suggestive of cardiac ischaemia lasting less than 30 minutes
- Symptoms are provoked by walking or other cardiovascular exercise
- Symptoms are relieved by rest or GTN
- Patients with known IHD not seen by cardiology >5yrs
- The patient can attend within 10 working days and are contactable by telephone
If there is possibility of myocardial infarction patients should be referred to A&E for urgent assessment. This includes angina symptoms that:
- Are increasing in severity.
- Have increased in frequency in recent days.
- Have prolonged rest pain > 20 minutes within last 12 hours.
- Have had prolonged ischaemic chest pain at rest.
Exclusions:
- Known IHD, MI within 1 year and/or under current cardiology review
- The patient has had a normal myocardial perfusion scan, CT coronary angiogram or coronary angiogram within the last 5 years
- The patient complains of a single episode of chest pain lasting less than 20mins
- The symptom occur predominantly at rest or at night
- The patient has a new murmur, cardiac arrhythmia or signs of heart failure. Please see alternative Cardiology pathways on Refhelp
- If patient has atypical pain with 2 or more risk factors refer to General Cardiology.
If there are immediate concerns about appropriateness of referral to the RACP then please contact the Cardiology Registrar on call.
