Rapid Access Angina Clinic - Nurse Led

The Nurse-Led Rapid Access Angina Clinic is for the rapid assessment and investigation of suspected angina. Patients who are felt to have angina should be commenced on antianginal therapy in accordance with NICE Guideline CG126 as per Formulary guidance.

Patients with suspected acute coronary syndromes (as per NICE Guideline GC95) should be admitted via the Medical Triage Unit. Patients with ongoing cardiac chest pain or acute electrocardiogram (ECG) changes should be admitted urgently via 999 ambulance.

Patients referred to this clinic will see a specialist nurse trained in the assessment of angina.

In Scope
  • Essential criteria for referral (all 3 must be ticked):
    • Suspected Angina (at least 2 of the following criteria)
    • Constricting discomfort in the front of the chest, or in the neck, shoulders, jaw, or arms
    • Precipitated by physical exertion
    • Relieved by rest or glyceryl trinitrate (GTN) within about 5 minutes
  • Onset within 12 weeks
  • Male aged over 30 or female aged over 40

Please note that the clinic is open to all patients with suspected new-onset angina even if the patient has known coronary artery disease (previous investigations, Percutaneous Coronary Intervention (PCI) or bypass grafting).

If procedures have been performed elsewhere, it would be extremely helpful if any relevant correspondence could be attached please.

Out of Scope

This is a nurse-led service and other conditions fall outside of their scope of practice and such referrals will unfortunately not be able to be seen. Patients under follow-up in a cardiology clinic should be flagged to the specific consultant.

Patients with other cardiac symptoms (e.g. palpitations), or chest pain in the context of suspected heart valve disease, should be referred to a consultant cardiology clinic.

Please use the Advice & Guidance service if appropriate, or make a referral to the General Cardiology service.

Assessment

History, Examination & Investigations

The referral should be made via the mandatory proforma and should include;

  • Presenting symptoms and duration
  • Cardiac Risk Factors:
    • Smoker or ex-smoker
    • Diabetes
    • Hypertension
    • Dyslipidaemia
    • Family history of premature coronary artery disease
    • Other proven cardiovascular/atheromatous disease; specify
  • Prescribed medication
  • Past Medical History

The following are mandatory to include (referrals will be returned if not included)

  • Body Mass Index (BMI)
  • Blood Pressure
  • Smoking Status
  • Pulse
  • Bloods Results - Haemoglobin, HbA1c, Renal Function and Lipid Profile (Non-Fasting)
  • ECG (attached to referral)

Management

  1. GP assesses patient and suspects angina. GP starts antianginal therapy in accordance with NICE Guideline CG126 and safety nets appropriately
  2. GP refers using the mandatory proforma and attaches ECG
  3. A dedicated secretary will book patients into clinics within 2 weeks
  4. History by specialist nurse
  5. Examination by specialist nurse
  6. Specialist nurse will decide on appropriate management and use of available investigations as per NICE guidance, applied according to our patient population risk. These investigations include:
    1. none required
    2. coronary computed tomography (CT) angiogram
    3. stress cardiac magnetic resonance (CMR)
    4. stress echo
    5. coronary angiography without pressure wire assessment
    6. coronary angiography and intracoronary pressure wire assessment of ischemia
  7. The GP will receive follow up correspondence with the results of the investigations and a revised management plan

Referral

  • Essential criteria for referral (all 3 must be ticked):
    • Suspected Angina (at least 2 of the following criteria)
    • Constricting discomfort in the front of the chest, or in the neck, shoulders, jaw, or arms
    • Precipitated by physical exertion
    • Relieved by rest or glyceryl trinitrate (GTN) within about 5 minutes
  • Onset within 12 weeks
  • Male aged over 30 or female aged over 40

Please note that the clinic is open to all patients with suspected new-onset angina even if the patient has known coronary artery disease (previous investigations, PCI or bypass grafting).

If procedures have been performed elsewhere, it would be extremely helpful if any relevant correspondence could be attached please.

Referrals may be returned if the criteria are not evident in the referral letter.

The referral should be made via the mandatory proforma and should include;

  • Presenting symptoms and duration
  • Cardiac Risk Factors:
    • Smoker or ex-smoker
    • Diabetes
    • Hypertension
    • Dyslipidaemia
    • Family history of premature coronary artery disease
    • Other proven cardiovascular/atheromatous disease; specify
  • Prescribed medication
  • Past Medical History

The following are mandatory to include (referrals will be returned if not included)

  • Body Mass Index (BMI)
  • Blood Pressure
  • Smoking Status
  • Pulse
  • Bloods Results - Haemoglobin, HbA1c, Renal Function and Lipid Profile (Non-Fasting)
  • ECG (attached to referral)

Referral Instructions

e-Referral Service Selection

  • Priority: Urgent
  • Specialty: Cardiology
  • Clinic Type: Rapid Access Chest Pain inc Exercise ECG
  • Service: Rapid Access Chest Pain Referral Assessment Service - Cardiology Dept-RDE-RH8
  • Click 'Send for Triage

Referral Forms

Rapid Access Chest Pain Clinic Referral Form

Supporting Information

Pathway Group

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group.

Publication date: August 2019

 

Home > Referral > Eastern locality > Cardiology > Rapid Access Angina Clinic - Nurse Led

 

  • First line
  • Second line
  • Specialist
  • Hospital