National Survey of Rapid Access Chest Pain Clinics in Australia

Abstract

Rapid access chest pain clinics (RACCs) are an innovative outpatient pathway that allows low-intermediate risk patients to avoid hospitalisation. However, the extent of RACCs in Australia is unknown. We aimed to identify Australian RACCs and describe the characteristics and landscape of this model of care in Australia. Australian RACCs were identified through four pathways: 1) Systematic literature search; 2) Google Search; 3) Word of mouth via RACC leaders including through the National Health and Medical Research Council Translation Centres that form the membership of the Australian Health Research Alliance; and 4) through the Cardiac Society of Australia and New Zealand emailing list. All RACCs identified were invited to complete a survey exploring the clinic's characteristics. Twenty-five (25) RACCs were identified, and present in all Australian states and territories. All public (n=16 of 16, response rate=100%) and three private (n=3 of nine, response rate=33%) RACCs completed the survey, with most RACCs located in major cities (n=14, 74%). In the 2022 calendar year, responding RACCs reported assessing 7,718 patients. RACCs had a median waiting time of 8.5 days (interquartile range [IQR] 4-18 days), 10 RACCs assessed >50% of patients within 7 days of referral, and 11 RACCs assessed ≥80% of patients within 14 days. Service variations included: clinic days/week (median=3; IQR 1.25-4 days), patient volume (median=335; IQR 130-600; range, 96-1,674 patients/yr), staffing (all RACCs had at least one consultant), other RACCs involved cardiology advanced trainees (n=13), nursing staff (n=11), basic physician trainees or senior resident medical officers, that is, post-graduate year (PGY) 3+ (n=2), and PGY1/PGY2s (n=3). All clinics accepted emergency department referrals (n=19), with additional referrals from general practitioners in 12 RACCs, and in-hospital/other clinic referrals in nine. Telehealth was used in 13 clinics. The most common initial investigation was stress echocardiography (eight clinics), computed tomography coronary angiogram (six clinics), and exercise stress test (five clinics). Our survey is the first to describe the national implementation of RACC and map the delivery of care in Australia. An additional outcome is the development of a national network of centres to collaboratively develop a "best practice" model of care for RACCs to improve patient outcomes.