Initiation and Modification of Guideline Recommended Pharmacotherapy Within a Nurse-led Rapid Access Chest Pain Clinic—Influence of Anatomical Versus Functional Testing

Abstract

Whilst rapid access chest pain clinics (RACPC) may provide an opportunity for timely assessment, investigation and management of patients with chest pain, their impact on the prescription of important pharmacotherapy remains unclear. Furthermore, the influence of anatomical versus functional testing on prescribing practice is poorly understood. We assessed medication prescribing within a nurse-led, cardiologist supported, RACPC and the influence of the testing modality used. Patients attending RACPC were invited to participate, and written consent was obtained. Initiation or modification of cardiovascular medication (aspirin, statin, beta-blocker (BB), calcium channel blocker (CCB) and ACEi/ARB) was recorded in all registry participants at (1) clinic attendance and (2) following testing. Results were compared between patients undergoing anatomical (CTCA or invasive coronary angiography [ICA]) versus functional testing (MPS, ETT and stress echo [SE]). 2,514 patients attended RACPC, with 1,542 patients recruited to registry. At clinic attendance, 345 individual medication changes were recorded. Following testing, 813 changes were made; aspirin most commonly (41% of all changes), followed by statins (34%), BB (19%), ACEi/ARB (7%), and CCB (2%). Proportionally most changes were observed following MPS (46%, 144 patients), then CTCA (44%, 457 patients), ICA (43%, 97 patients), ETT (29%, 77 patients) and SE (14%, 15 patients). Overall, anatomical testing (CTCA and ICA) was associated with a greater rate of medication change than functional testing (MPS, ETT and SE); 44% vs 34%, p<0.001. Nurse-led RACPCs provide opportunities for medication initiation and modification. These occur more frequently following anatomical rather than functional testing.