Rapid access chest pain clinics - what's the evidence?
Mar 11, 2025
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Andrew Black, an interventional cardiologist from Royal Hobart Hospital and a researcher at the Menzies Institute, dives into the world of rapid access chest pain clinics. He discusses the critical importance of timely assessments and how these clinics can streamline patient care. The conversation highlights varying global practices and emphasizes the need for updated evidence to validate their effectiveness. With a focus on nurse-led models showing promising results, this discussion sheds light on the future of chest pain management.
Rapid access chest pain clinics efficiently manage patients with chest pain, improving outcomes while minimizing waiting times and healthcare costs.
Despite showing low rates of adverse events and cost-effectiveness, further rigorous research is needed to strengthen the evidence for RACPACs.
Deep dives
Importance of Rapid Access Chest Pain Clinics
Rapid access chest pain clinics (RACPAC) play a critical role in effectively managing patients who present with chest pain. These clinics were developed to quickly assess and differentiate between benign causes of chest pain and those requiring urgent medical intervention. Their structure allows for rapid evaluation and facilitated discharge of patients who are low risk, minimizing waiting times for new patients. This efficiency helps ensure that serious cardiac conditions are addressed promptly, ultimately improving patient outcomes and healthcare resource utilization.
Overview of Current Evidence and Historical Context
The current systematic review reveals a significant number of studies assessing the effectiveness of RACPACs, although the quality of evidence varies widely. The last comprehensive review prior to this one was conducted in 2002, revealing a lack of robust data supporting the model. Many studies were descriptive, and only a handful utilized randomized controls, which limits the generalizability of previous findings. This review found that RACPACs demonstrate low rates of adverse cardiovascular events and have shown positive outcomes, reinforcing their continued use despite previous calls for more rigorous research.
Cost-Effectiveness and Future Directions
RACPACs have been found to be cost-effective compared to traditional care methods due to lower rates of emergency department referrals and hospital admissions. The reduction in healthcare costs associated with establishing these clinics illustrates their potential to manage high volumes of patients efficiently without creating additional burdens on healthcare systems. However, the evidence base still requires more rigorous study designs, such as clinical registries, to further validate these findings and optimize these services. Exploring strategies to reduce unnecessary testing within RACPACs could also enhance their effectiveness in patient care.
In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by Dr Andrew Black from Tasmania, Australia. They discuss his paper that systematically reviewed the evidence for RACP clinics. If you enjoy the show, please leave us a podcast review wherever you get your podcast.