Dr Nayyar Naqvi from the Royal Albert Edward Infirmary (Wigan, UK) undertook a retrospective analysis of 920 patients referred by their GP for recent onset chest pain, suggestive of angina. Three, specially trained cardiac nurses saw the patients, and they followed a special protocol that included taking a history, patient examination, and exercise treadmill tests.
Dr Naqvi explained: “When junior doctors’ hours were reduced in the UK we found that our complement of doctors was insufficient to cope, and, from necessity, introduced nurse-led RACPCs.” He said the introduction of these clinics had been patchy across Europe and, as yet, had not been introduced in some countries such as France.
The key to the success of the clinics, said Dr Naqvi, lay in the quality of the nurses’ training. All three had been senior nursing sisters on the coronary care unit; they had extensive knowledge of electrocardiograms and heart rhythm disturbances, they were trained in resuscitation and held Adult Life Support certificates. All were supervised until cardiologists were confident they could conduct clinics independently.
In the study, 910 patients underwent exercise tolerance testing and 146 (16.1%) were identified as having a cardiac problem. Of these patients, 78 underwent cardiac catheterisation, and coronary artery disease was found in 64 patients. Twenty of these patients (31%) were treated medically and 44 patients (69%) underwent revascularisation procedures.
When a cardiologist reviewed the exercise tests, only four results were disputed, with nurses labelling the results as equivocal, while the cardiologist diagnosed them as negative. “The fact that such a low number were disputed demonstrates how well-trained and experienced our specialist nurses are,” he said
Furthermore, the study showed that 92% of patients were seen within the 14-day government target and no clinics were cancelled. “The result was that no patients were inconvenienced, and GPs got immediate results of ischaemic heart disease status, which in turn led to the earlier initiation of treatments,” said Dr Naqvi. “This has meant that disease progression may be halted, and that earlier intervention may save lives.”
The scheme also allowed cardiologists more time for more specialised tasks, such as performing catheterisation and cardiac imaging.
Dr Naqvi is analysing the economic benefits to the NHS Trust of employing nurses rather than doctors to conduct RACPCs.
If you would like to receive a copy of the Wigan Protocol for nurse-led RACPC email your request to Dr Naqvi at nayyar.naqvi@wwl.nhs.uk