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.

Keywords: COVID-19; Coronary artery disease; Costs and cost analysis; Virtual care.

Fig. 1

Workflow of the Rapid Access Chest Pain Assessment Clinic Referral and Assessment Pathway. This flowchart illustrates the referral sources and eligibility criteria for patients considered suitable for RACPC, including low to moderate risk chest pain, negative troponin, and absence of ischaemic ECG changes. It outlines the clinical steps from triage and baseline investigations to outpatient imaging and telehealth follow-up, with pathways leading to either discharge or further investigation(s). Emergency department (ED); General Practitioner (GP); RACPAC, Rapid Access Chest Pain Assessment Clinic.

Fig. 2

Trends in Cardiac Imaging Modalities Ordered by Year at the Rapid Access Chest Pain Assessment Clinic (RACPAC) (2012–2021). This line graph displays the annual number of investigations ordered through the Rapid Access Chest Pain Assessment Clinic (RACPAC) over 9 years. Modalities include CT coronary angiography (CTCA), treadmill stress echocardiography (TSE), myocardial perfusion scan (MPS), and invasive angiography (IA). A gradual increase in TSE use and variability in CTCA demand are evident over time.

Fig. 3. Central Illustration

Summary of the Virtual Rapid Access Chest Pain Assessment Clinic and Its Clinical and Economic Impact. This illustration highlights the design and outcomes of a retrospective study involving 3976 patients referred to the Rapid Access Chest Pain Assessment Clinic (RACPAC) between July 2012 and July 2021. It compares face-to-face care (2012–2019) with virtual care delivery (2020–2021) for low-to-intermediate risk chest pain. Major findings include improved attendance rates (from 86 % to 94 %), reduced hospital bed-stays (460 days saved), and an annual cost-saving of AUD 283,663. The figure also presents cardiac imaging performance metrics with revascularisation rates for treadmill stress echocardiography (TSE: 26.7 %), CT coronary angiography (CTCA: 34.6 %), and invasive angiography (IA: 33.3 %).