Authors (including presenting author) :
Chiu SH(1), Tsui PT(1), Candic Tang MK(1)
Affiliation :
(1)Cardiac Team, Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong
Introduction :
There are many causes of chest pain, some of which are benign with a non-cardiac origin, while others are potentially life-threatening, such as acute myocardial infarction (AMI) and coronary heart disease (CHD). In Princess Margaret Hospital (PMH), long waiting time for the first cardiology consultation, slow progress to definite diagnosis or treatment and clinic overtime has reached critical point. Such prolonged duration of time to diagnosis inadvertently put patients to a greater risk.
Objectives :
1.To provide rapid access and early assessment of patients with suspected CHD
2.To perform protocol driven investigations and risk stratification 3.To promote cardiovascular disease (CVD) prevention
Methodology :
The nurse-led out-patient CPC was established in June 2017 in PMH. Patients with atypical chest pain, and suspected to have CHD, having a general medical appointment exceeding 12 months, would be invited to attend the CPC. An objective risk stratification algorithm based on symptomology and Framingham risk scores were used to classify patients into low, moderate and high-risk groups. After the comprehensive assessment, further investigations with protocol guided would be prescribed. The nurse evaluated patients’ symptoms and explained the results to them during the follow-up consultation. Lastly, patients were referred to Cardiologist for the decision of case closed. The records were reviewed retrospectively to evaluate management outcome by nurse-led CPC versus the usual care. Patients were randomly chosen from usual pathway with both sex and age (+/-1) matched from CPC. The revision of treadmill result was counted as the study endpoint.
Result & Outcome :
From June 2017 to April 2018, there were 29 patients attended the CPC. 1(3.4%) high-risk patient received early invasive intervention. 3(10.3%) patients defaulted the medical follow up after investigations result was reviewed by nurse. 13(44.8%) of them did not show any evidence of CHD with case closed after first medical consultation. The remaining 12(41.4%) patients continued medical followed up due to other medical diseases were suspected. The total episodes of medical consultation was 26 (median 1) in CPC versus 147 (median 5.5) in usual pathway. The follow-up duration (months) per patient from the first consultation to case closed was greatly shorten from median 18.5 (7-23) in usual pathway to median 4 (3-8) in CPC. Result also showed that advanced patients to CPC can greatly reduce accident & emergency department (AED) utilization from 24.5% to 3.4% with 6 months at study endpoint. Moreover, there was no acute cardiac event or unplanned admission reported. Post-service high patient satisfaction score with median 3.93(out of 4) was awarded. The nurse-led CPC is safe and more cost effective than the usual care in managing patients with atypical chest pain.
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