SUSPECTED NEW ONSET STABLE ANGINA

GLOUCESTERSHIRE HOSPITALS RAPID ACCESS CHEST PAIN CLINIC (RACPC) REFERRAL FORM

(2-WEEK WAIT RULE)

Updated December 2016

Patient Details / Referrer details
Surname: / Referring GP:
Forename: / Usual GP:
Address: / Address:
Postcode: / Postcode:
Home tel: / Tel:
Daytime tel: / Fax:
Date of Birth
NHS Number: / Referred On:

The primary aim of the Rapid Access Chest Pain service is for the identification of patients with possible new onset angina in males over 30 years and females over 40 years of age.

Any other suspected cardiac conditions should be referred to general cardiology clinics.

Patients with suspected acute coronary syndromes (acute MI or unstable angina) should be referred to the Emergency Department

Patients having an established diagnosis of ischaemic heart disease should only be referred as long as they are no longer under active follow up within cardiology and as long as the symptoms are genuinely re-emergent.

Referral criteria:

Patients presenting with (please tick number of features below);

·  Constricting discomfort to the front of the chest, neck, shoulders, jaw or arms.

·  Precipitated by physical exertion or emotional stress.

·  Relieved by rest or GTN in about 5 minutes

3 features TYPICAL ANGINA refer to RACPC

2 features ATYPICAL ANGINA refer to RACPC

1 or no features NON ANGINAL PAIN if ECG is normal, consider other cause, do not refer to RACPC without discussion with one of the Specialist Nurses (contact details below).

Assess CVD risk factors; please tick box

Smoking Yes Ex Pack Hx Never

Diabetes Yes Type No

Hypertension Yes No

Hypercholesterolaemia (total cholesterol >6.5mmol/l)

Early family history (M <65 yrs, F< 60yrs) Yes No

Mandatory additional information (the referral cannot be accepted without these):

·  Resting 12 lead ECG.

·  List of medication

·  Full set of bloods within the 3 months prior to the referral (FBC, U&E, lipids, sTSH,

·  Glucose/HbA1c)

Free text – brief summary of HPC or pertinent background information:


This service is for the urgent referral of patients with SUSPECTED NEW ONSET STABLE ANGINA, with the aim of seeing the patients in clinic within 2 weeks of referral. Clinics are held every weekday and may be in either GRH or CGH.

The referral form itself provides the referral information required.

Patients who are not to be suitable for RACPC are:

·  Females younger than 40 years, males younger than 30 years (highly unlikely to have important flow limiting coronary disease)

·  Patients with uncontrolled hypertension (unsafe for exercise testing). Please treat first.

·  Patients already referred to main cardiology because there is a longer wait. This causes duplication and reduces appointment slot availability for other patients.

·  Patients with palpitations, known valvular heart disease, multiple or significant co-morbidities (please refer to main cardiology).

·  Patients requiring a general cardiology review.

·  Elderly patients (ie more than 80yrs) with typical symptoms can safely be commenced on antianginal therapy as a first line of treatment. Referral is then welcomed if the symptoms are not adequately controlled.

·  Patients who have had normal coronary angiography or CT coronary angiography within the last 3 years (highly unlikely to have developed important flow limiting coronary disease in such a short time frame).

Structure of clinics.

The patient will have a repeat 12 lead ECG on arrival, a full history taken and an examination by a cardiology specialist nurse or registrar. Subsequent tests may include CT coronary angiography, exercise treadmill testing, myocardial perfusion imaging or invasive coronary angiography and will depend on the individual need of the patient. This will be explained to the patient in clinic at the time. These tests will be carried out on return visits. Feedback to the referrer will be within 24 hours.

If you have any queries the Specialist Nurses’ contact details are:

Sandra Wheeler, 0300 422 8281

Alison Halliday, 0300 422 8281

This communication is CONFIDENTIAL. If received in error,

please call 0300 422 5985

For further information & guidance, please contact

Sandra Wheeler or Alison Halliday on 0300 422 8281