Authors (including presenting author) :
Chan KHA(1), Li WCP(2), Chau MY(3), Wong CK(4)
Affiliation :
(1) School of Nursing, The University of Hong Kong
(2) School of Nursing, The University of Hong Kong
(3) Cardiology Unit, Department of Medicine, Queen Mary Hospital
(4) Department of Medicine, The University of Hong Kong
Introduction :
The purpose of this study is to evaluate the impact of the Chest Pain Clinic(CPC).
Cardiovascular diseases are the leading cause of death globally. In Hong Kong, heart disease is the fourth leading cause of death in 2022. With rapid aging of the population and the increasing prevalence of behavioral risk factors, the disease burden associated with CAD is expected to keep an exponential increasing trend.
The treatment goals for CAD are to reduce cardiovascular event rates and improve prognosis. A confirmed diagnosis of CAD is mandated before the initiation of these treatments.
Chest pain is a common symptom of CAD and one of the most common chief complaints for people seeking medical care. Due to the potential underlying cardiac causes, efficient management of chest pain is crucial to ensure early diagnosis. Hence, it helps to provide treatment modalities and to improve patients’ health outcomes and ultimately to reduce the burden associated with downstream cardiac diseases.
Chest pain clinic (CPC) has been firstly introduced in western countries a decade ago and this service typically involve cardiologists and cardiac specialty nurses to provide a safe, efficient, and cost-effective evaluation of patients with new onset chest pain.
CPC has been implemented since 2022 as a pilot service in Queen Mary Hospital. The service adopted an integrated interprofessional approach with cardiologists and cardiac specialty nurses to risk stratifying patients with chest pain. The sources of referral include specialty out-patient clinics (SOPC), General Practitioners or Emergency Departments. Since then, approximately 350 patients have received the CPC service. In view of the knowledge gaps regarding the effects of CPC, it is timely to conduct a service evaluation study to examine the effects of the CPC service.
Objectives :
1. To examine the impact of the CPC service on referral time to cardiologist consultation, incidence to diagnose Coronary Artery Disease (CAD)
2. Explore CAD patients on uncertainty, anxiety, health related quality of life (HRQoL) and functional status among patients with chest pain.
3. To explore the chest pain characteristics and related risks associated to CAD
Methodology :
A prospective non-randomized quantitative study design will be adopted. Participants will be recruited from among the cohort who receive CPC service to comprise the CPC group, a second group of chief complaint of chest pain will be recruited from the SOPC to comprise the comparison group.
This study will be conducted in the Department of Cardiology and SOPC of a University-affiliated hospital in Hong Kong.
A consecutive sampling method will be used to recruit participants. Patients aged over 18 years or older with the complaint of chest pain and being referred to CPC or SOPC of the study hospital will be included in the study. Patients having a confirmed diagnosis of CAD or AMI, confirmed non-cardiac origin diagnosis related to chest pain will be excluded. In addition, those with impaired cognition (with Abbreviated Mental Test < 6) and communication hindering data collection will be excluded.
The study will conduct for 6 months with 3 time-point of assessment including initial (before consultation), 3-month and 6-month period.
Result & Outcome :
Interim result:
Total 102 patients recruited with 80 from CPC and 22 from SOPC.
The average days of referral to consultation showed statistically significant result(P< 0.01) is 75.78days (SD:37.18) and 98.36 days (SD:24.33) respectively.
The average days of referral to assessment is 7.46days (SD:10.66) and 9.47days (SD:7.59) (P=0.4).
There is no significant demographic characteristics between groups.
Characteristics of CAD patients in initial phase(T0): Before the consultation
Risks factors including hypertension, hyperlipemia, obesity, hyperglycaemia and smoking shows higher incidence in CAD than in no CAD group.
Symptoms of Acute Coronary Syndrome Index-Chinese (SACSI-C) is used to examine the chest pain characteristics. There is an association between mid-back pain and Coronary Artery Disease (p=0.016). CAD cases located pain in left and centre of chest, left arm and shoulder, jaw, right arm and upper abdomen area. They described quality of pain as pressure, dull and tightness.
The CAD group reported hospital anxiety and depression scale (HADS) mean score is 4.81(SD:3.67).
Seattle Angina Questionnaire (SAQ-7) mean score is 85.26(physical limitation), 84.11(angina frequency) and 34.11 (quality of life).
International Physical Activity Question (IPAQ-SF) mean is 1408.14 MET/min/week.
Health related Quality of life (EQ5D5L) mean score is 0.88.
Mishel Uncertainty in Illness Scale(MUIS-C) mean score is 93.61.
