Rapid Access Chest Pain Assessment Clinic: An Australian Virtual Care Experience.

Abstract

Background: The Rapid Access Chest Pain Assessment Clinic (RACPAC) streamlines the evaluation of low to intermediate-risk chest pain patients, reducing hospitalisation and healthcare costs. However, there is limited data on the virtual model of care for RACPAC.

Aim: We sought to evaluate the structure, cost-effectiveness, and imaging modalities performance of face-to-face and virtual RACPAC in an Australian setting.

Methods: A retrospective analysis of patients attending the RACPAC within a large Australian quaternary hospital between 2012 and 2021. We described the clinic parameters and imaging modality utilisation with parametric and non-parametric descriptive statics. Patterns of diagnostic modality utilisation were assessed with logistic regression. A p-value<0.05 was considered statistically significant.

Results: 3976 consecutive patients attended RACPAC, with a mean age of 55.2 years (±11.6), and 48.7 % were females. RACPAC transitioned to Virtual service during the COVID-19 pandemic, witnessing the highest attendance rate at 95 %, despite increased patient load by 10.7 %, with a lower re-presentation rate of 1.5 % compared to 2.8 % pre-pandemic (p < 0.01). The revascularisation rates were 34.6 % after positive CT coronary angiogram, 26.7 % for Treadmill Stress Echocardiogram, 20 % for Myocardial Perfusion Scan, and 33.3 % for Invasive Angiogram. The cost-effective analysis of virtual care reduced evaluation costs to one-fourth, with 460 days of in-hospital stays and AUD 283,663 of cost saved annually.

Conclusion: This study highlights the feasibility, cost-effectiveness and acceptability of virtual RACPAC, emphasising its potential to extend RACPAC services to remote areas or limited-resource countries. It underscores CTCA's utility as a diagnostic tool in the RACPAC setting.