None listed
Conditions
Brief summary
Patients with new onset chest pain, suggestive of angina pectoris, are at high risk of acute cardiac events including myocardial infarction and death. Chest pain remains one of the most common reasons for presentation to the emergency department and hospital admission. In 2013-14, 653,572 presentations to emergency departments within Australia were attributed to ‘circulatory system illness’, 9.4% of all emergency presentations. The majority of patients presenting to hospital with recent onset chest pain are ultimately found to have a non-cardiac cause for their symptoms, or no definite diagnosis is made. Others may have an acute coronary syndrome (ACS) and require urgent admission and treatment. Appropriate risk stratification and triaging of all patients with chest pain is therefore crucial. New onset chest pain remains a common clinical presentation. Establishing efficient clinical care pathways, such as a rapid access chest pain clinic (RACPC), may help to reduce unnecessary and costly presentations to emergency departments and hospital admissions. However, among patients with an intermediate pre-test likelihood it remains unclear as to which test is best to perform. This project aims to assess the impact of a RACPC and to better understand the role of currently recommended investigations, such as exercise treadmill tests, CT coronary angiography and myocardial perfusion scans, among patients who attend the clinic with an intermediate pre-test likelihood of significant coronary artery disease.
Interventions
Patients attending the rapid access chest pain clinic shall be invited to participate. Individuals assessed as being at intermediate risk of significant coronary artery disease shall be randomised to one of three routinely used investigations; exercise treadmill test (ETT), CT coronary angiogram (CTCA) or a myocardial perfusion scan (MPS).
Exercise treadmill test, involves monitoring your heart whilst you walk quickly on a treadmill, similar to those found in a gym. The test is performed by exp
Patients attending the rapid access chest pain clinic shall be invited to participate. Individuals assessed as being at intermediate risk of significant coronary artery disease shall be randomised to one of three routinely used investigations; exercise treadmill test (ETT), CT coronary angiogram (CTCA) or a myocardial perfusion scan (MPS). Exercise treadmill test, involves monitoring your heart whilst you walk quickly on a treadmill, similar to those found in a gym. The test is performed by experienced exercise physiologists, within the cardiology department at Royal Perth Hoispital, and usually takes about 10-12 minutes. CT coronary angiogram; involves an injection of dye into a blood vessel in your arm, whilst an X-ray scan of your heart is performed. Occassionally a single small dose of a medicine (beta blocker) may be given to you in order to slow your heart down to optimise the images. The CT scan takes just a few minutes and is performed by radiologists. Myocardial perfusion scan; involves an assessment of the blood flow to your heart muscle under conditions of rest and stress (either exercise on a treadmill, or following the injection of a medicine to relax your blood vessels and speed up the flow of blood in your heart (coronary) arteries). This scan involves the injection of a small amount of radioactive tracer. The two scans take about an hour each and are performed on two consecutive days. The scans are performed by radiologists within the Nuclear Medicine department at Royal Perth Hospital.
Sponsors
Royal Perth Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Diagnosis
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
Inclusion criteria: age 18–85 years with new onset (<3 months) chest pain, suggestive of stable angina pectoris. Our target population includes patients who live within the RPH postcode-allocated referral areas and patients whom live rurally / remotely who would normally be referred to RPH.
Exclusion criteria
Exclusion criteria: Patients with acute coronary syndrome (ACS) are excluded from this service and should be referred via conventional pathways, such as referral to ED. Other exclusions include: known coronary artery disease, significant cognitive impairment, multiple co-morbidities (involving current input from other clinical specialists), significant valvular heart disease or suspected arrhythmia and advanced renal failure (eGFR <30ml/min). These patients will continue to be assessed in the general cardiology outpatient clinics.
Outcome results
None listed