Patients sometimes assume that chest pain must be due to heart attack, but chest pain has many other possible causes, such as gastroesophageal reflux disease, heartburn, esophageal spasms or panic attack. Fast and accurate diagnosis allows heart patients to receive prompt medical care and spares noncardiac patients from invasive and expensive tests.

Researchers in Great Britain invited physicians and hospitals to refer patients with chest pain, palpitations (fast heartbeat) and shortness of breath to a rapid-access (no appointment needed) cardiology clinic at Charing Cross Hospital in London. During a 12-month period the clinics saw 1,223 patients, and 77 percent of them agreed to answer a questionnaire one year later.

Of these 940 participants, 66 percent received a noncardiac diagnosis, 23 percent a cardiac diagnosis and 11 percent a diagnosis of possible heart disease. At the one-year follow-up, 98 percent of the patients with no initial cardiac diagnosis still had not been diagnosed with a cardiac condition.

Patients with a definite cardiac diagnosis had a cardiac mortality rate of 3 percent a year later, compared to an expected cardiac mortality rate of 0.9 percent for their general age group. Those with a noncardiac or indefinite cardiac diagnosis had a cardiac mortality rate of 0.3 percent a year later, compared to an expected cardiac mortality rate of 0.4 percent for their general age group.

The researchers concluded that rapid-access cardiology clinics could correctly distinguish high-risk cardiac patients from those without significant heart disease.

The study was published this month in the journal Heart.

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