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07. Syncope and Bradycardia
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32. Cardiovascular Nursing
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Rapid-Access Chest Pain Consultation: Implementation of a Programme for Early Diagnosis and Personalised Stratification of Coronary Artery Disease
Session:
Sessão de Posters 46 - Síndromes coronárias agudas: vias, atrasos e impacto das recomendações
Speaker:
Francisca Nunes
Congress:
CPC 2026
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.3 Coronary Artery Disease – Diagnostic Methods
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Francisca Martins Nunes; Marta Catarina Almeida; Francisco Lemos de Sousa; Leonor Moura; Inês Rodrigues; António Gonçalves; André Lobo; Inês Neves; Marta Leite; Rita Faria; Nuno Dias Ferreira; Ricardo Fontes-Carvalho
Abstract
<p>Background: Chronic coronary syndrome (CCS) presents in a heterogeneous manner, ranging from stable angina to ischemic heart failure or asymptomatic patients with imaging/electrocardiographic abnormalities. The correct stratification of these patients depends on the availability of complementary diagnostic tests-particularly functional testing as coronary CT angiography (CCTA)- and on the rapid response time to first visit, a frequent obstacle to early referral.Thus, there is an unmet need to create innovative organizational models that enable personalized risk assessment and early patient orientation. As such, we developed the Rapid Access Chest Pain Consultation based on structured protocols that integrate clinical assessment, advanced imaging and early intervention.</p> <p>Methods: This program was implemented in November 2024 covering patients who meet specific acceptance criteria. The consultation request must include a detailed description of the chest pain. If eligible, the patient is summoned and evaluated by a cardiologist, undergoing CCTA on the same day. Then, based on the CAD-RADS 2.0 classification the patient is referred to the attending physician or for additional testing (ischemia study in <3 months or invasive coronary angiography [ICA] in <2 weeks, as applicable). Cardiovascular risk factors are optimized and prognosis-modifying and anti-ischemic therapy titrated as needed.</p> <p>Results: To date, a total of 127 patients have been evaluated, summoned for consultation within a median time of 30 days. Most are men (59.1%) with a mean age of 61.1y. The median pre-test probability (PTP) of CCS was 11.0% (low PTP, 41.5%) which according to guidelines supports using CCTA to rule out CAD. Only 32% had symptoms compatible with cardiac chest pain. 108 (85.0%) patients underwent CCTA with a median calcium score of 53.8 Hounsfield Units. After excluding obstructive CAD 63 patients (49.6%) were discharged to their attending physician. Of the remaining 26.7% were referred for ischemia testing and 13.4% for ICA, performed in a median of 28.5 days (IQR 8.0-25.0). Follow-up was then ensured in cardiology consultations. </p> <p>Discussion/Conclusion: This protocol has proven to be feasible and effective, allowing most patients to obtain diagnostic and therapeutic guidance after a single hospital visit. The Rapid Access Chest Pain Consultation represents an innovative model of clinical practice with clear gains in care efficiency, early diagnosis and personalization of care.</p>
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