Objective: To conduct a one year follow up study of patients seen In a combined rapid access chest pain, arrhythmia and heart failure clinic. Methods: Local general practitioners, accident and emergency department cli...Objective: To conduct a one year follow up study of patients seen In a combined rapid access chest pain, arrhythmia and heart failure clinic. Methods: Local general practitioners, accident and emergency department clinicians and other hospital clinicians were invited to refer patients with a new presentation of chest pain, palpitations and suspected cardiac-induced breathlessness to the rapid access cardiology clinics at Charing Cross Hospital, London, on a one-stop, no appointment basis. Consent to be followed up by a postal questionnaire one year later was sought from all patients attending between 1 November 2002 and 31 October 2003. Results: 1223 patients were seen in the 12 month study period. 940(77%) consented to one year follow up. 216(23%) patients had a diagnosis of definite cardiac, 621(66%) of not cardiac and 103 of possible cardiac disease(11%). 98%of patients diagnosed “not cardiac”did not receive a diagnosis of cardiac disease over the following 12 months. Of patients with diagnosed definite cardiac disease, one year cardiac mortality was 7 of 216(3%), compared with an age-and sex-matched expected cardiac mortality of 0.9%(standardised mortality ratio 3.5, 95%confidence interval(CI)1.4 to 7.2). For patients with an initial diagnosis of possible or not cardiac disease, cardiac mortality at one year was 0.3%compared with an expected cardiac mortality of 0.4%(standardised mortality ratio 0.8, 95%CI 0.1 to 2.8). Conclusions: A rapid access cardiology clinic accurately diagnoses and risk stratifies patients into those with cardiac disease at high risk of cardiac death and those without significant cardiac disease.展开更多
Objective: To investigate whether a rapid access approach is useful for the ev aluation of patients with symptoms suggestive of a new cardiac arrhythmia. Desig n: Prospective, descriptive study. Setting: Secondary car...Objective: To investigate whether a rapid access approach is useful for the ev aluation of patients with symptoms suggestive of a new cardiac arrhythmia. Desig n: Prospective, descriptive study. Setting: Secondary care based rapid access ar rhythmia clinic in West London, UK. Participants: Patients referred by their gen eral practitioner or the emergency department with symptoms suggestive of a new cardiac arrhythmia. Main outcome measures: Number of patients with a newly diagn osed significant arrhythmia. Number of patients with diagnosed atrial fibrillati on. Number of eligible, moderate, and high risk patients treated with warfarin. Results: Over a 25 month period 984 referrals were assessed. The mean age was 55 years (range 20-90 years) and 56%were women. The median time from referral to assessment was one day. A significant cardiac arrhythmia was newly diagnosed in 40%of patients referred to the RAAC. The most common arrhythmia was atrial fib rillation, with 203 new cases (21%). Of these, 74%of eligible patients over 65 were treated with warfarin. Other arrhythmias diagnosed were supraventricular tachycardias (127(13%)), conduction disorders (43 (4%)), and non-sustained ventricular tachycardia (21 (2%)). Vasovagal syn cope was diagnosed for 53 patients (5%). The most frequent diagnosis was sympto matic ventricular and supraventricular extrasystoles (355 (36%)). Conclusion: A rapid access arrhythmia clinic is an innovative approach to the diagnosis and m anagement of new cardiac arrhythmias in the community. It provides a rapid diagn osis, stratifies risk, and leads to prompt initiation of effective treatment for this population.展开更多
文摘Objective: To conduct a one year follow up study of patients seen In a combined rapid access chest pain, arrhythmia and heart failure clinic. Methods: Local general practitioners, accident and emergency department clinicians and other hospital clinicians were invited to refer patients with a new presentation of chest pain, palpitations and suspected cardiac-induced breathlessness to the rapid access cardiology clinics at Charing Cross Hospital, London, on a one-stop, no appointment basis. Consent to be followed up by a postal questionnaire one year later was sought from all patients attending between 1 November 2002 and 31 October 2003. Results: 1223 patients were seen in the 12 month study period. 940(77%) consented to one year follow up. 216(23%) patients had a diagnosis of definite cardiac, 621(66%) of not cardiac and 103 of possible cardiac disease(11%). 98%of patients diagnosed “not cardiac”did not receive a diagnosis of cardiac disease over the following 12 months. Of patients with diagnosed definite cardiac disease, one year cardiac mortality was 7 of 216(3%), compared with an age-and sex-matched expected cardiac mortality of 0.9%(standardised mortality ratio 3.5, 95%confidence interval(CI)1.4 to 7.2). For patients with an initial diagnosis of possible or not cardiac disease, cardiac mortality at one year was 0.3%compared with an expected cardiac mortality of 0.4%(standardised mortality ratio 0.8, 95%CI 0.1 to 2.8). Conclusions: A rapid access cardiology clinic accurately diagnoses and risk stratifies patients into those with cardiac disease at high risk of cardiac death and those without significant cardiac disease.
文摘Objective: To investigate whether a rapid access approach is useful for the ev aluation of patients with symptoms suggestive of a new cardiac arrhythmia. Desig n: Prospective, descriptive study. Setting: Secondary care based rapid access ar rhythmia clinic in West London, UK. Participants: Patients referred by their gen eral practitioner or the emergency department with symptoms suggestive of a new cardiac arrhythmia. Main outcome measures: Number of patients with a newly diagn osed significant arrhythmia. Number of patients with diagnosed atrial fibrillati on. Number of eligible, moderate, and high risk patients treated with warfarin. Results: Over a 25 month period 984 referrals were assessed. The mean age was 55 years (range 20-90 years) and 56%were women. The median time from referral to assessment was one day. A significant cardiac arrhythmia was newly diagnosed in 40%of patients referred to the RAAC. The most common arrhythmia was atrial fib rillation, with 203 new cases (21%). Of these, 74%of eligible patients over 65 were treated with warfarin. Other arrhythmias diagnosed were supraventricular tachycardias (127(13%)), conduction disorders (43 (4%)), and non-sustained ventricular tachycardia (21 (2%)). Vasovagal syn cope was diagnosed for 53 patients (5%). The most frequent diagnosis was sympto matic ventricular and supraventricular extrasystoles (355 (36%)). Conclusion: A rapid access arrhythmia clinic is an innovative approach to the diagnosis and m anagement of new cardiac arrhythmias in the community. It provides a rapid diagn osis, stratifies risk, and leads to prompt initiation of effective treatment for this population.
