27.4.20 Rapid Access Chest Pain Clinic
Further to Friday Primary Care GP Question and Answer Session here is a fuller explanation about the Rapid Access Chest Pain Clinic.
All the patients referred to the RACPC who were not seen prior to the pandemic stopping face to face out patient consultations where possible, the GPs were written to, indicating if they had a significant concern that they patient did have angina then they should give appropriate anti angina and prevention medication given further investigations which might normally be recommended such as stress testing or CT scanning, or in some cases angiography, were not going to be available for outpatient investigation especially during the surge phases. This allowed patients who do have coronary disease to be appropriately managed and protected and those who may not, unlikely to come to harm with medication. Obviously, any patient who became unstable with suspected ACS would need to be admitted to hospital through the normal pathway of care.
Recognising that there may still be some patients who the GP is concerned about and needs further input we are providing a rapid Advice & Guidance service at a consultant level. The relevant consultant can still ask for investigations if deemed essential. However, in patient with chronic coronary syndromes, there is no evidence of prognostic benefit from intervention and this is reserved for those who continue to struggle despite medical therapy. As such, the unit are not currently undertaking stress echo but do have access to both MRI and CT scanning, although the latter is limited as this is a key COVID respiratory investigation.
Through the A&G process, we have admitted patients to hospital where we feel this is necessary, and can also provide a limited telephone consultation if this is felt necessary by the responsible consultant. However, the vast majority of patients will be both protected and in many cases substantially improved with the medication and not need further assessment even post COVID.
The key message for the GP forum is that protecting patients with suspected coronary disease and angina with medical therapy is the best management at present. If, having done so, or they feel the situation is more complex, then the Advice and Guidance process is available to support this. The new way of working through the A&G process is likely to be one of the things retained, along with more streamlined and virtual outpatient clinics, after the Covid crisis.
This briefing was provided in consultation with Iain A Simpson MD FRCP FACC FESC, Consultant Cardiologist, Wessex Regional Cardiac Unit