Abstract
BackgroundRapid access chest pain clinics have facilitated the early diagnosis and treatment of patients with coronary heart disease and angina. Despite this important service provision, coronary heart disease continues to be under-diagnosed and many patients are left untreated and at risk. Recent advances in imaging technology have now led to the widespread use of noninvasive computed tomography, which can be used to measure coronary artery calcium scores and perform coronary angiography in one examination. However, this technology has not been robustly evaluated in its application to the clinic.Methods/designThe SCOT-HEART study is an open parallel group prospective multicentre randomized controlled trial of 4,138 patients attending the rapid access chest pain clinic for evaluation of suspected cardiac chest pain. Following clinical consultation, participants will be approached and randomized 1:1 to receive standard care or standard care plus ≥64-multidetector computed tomography coronary angiography and coronary calcium score. Randomization will be conducted using a web-based system to ensure allocation concealment and will incorporate minimization. The primary endpoint of the study will be the proportion of patients diagnosed with angina pectoris secondary to coronary heart disease at 6 weeks. Secondary endpoints will include the assessment of subsequent symptoms, diagnosis, investigation and treatment. In addition, long-term health outcomes, safety endpoints, such as radiation dose, and health economic endpoints will be assessed. Assuming a clinic rate of 27.0% for the diagnosis of angina pectoris due to coronary heart disease, we will need to recruit 2,069 patients per group to detect an absolute increase of 4.0% in the rate of diagnosis at 80% power and a two-sided P value of 0.05. The SCOT-HEART study is currently recruiting participants and expects to report in 2014.DiscussionThis is the first study to look at the implementation of computed tomography in the patient care pathway that is outcome focused. This study will have major implications for the management of patients with cardiovascular disease.Trial registrationClinicalTrials.gov Identifier: NCT01149590
Highlights
Rapid access chest pain clinics have facilitated the early diagnosis and treatment of patients with coronary heart disease and angina
The SCOT-HEART study is currently recruiting participants and expects to report in 2014. This is the first study to look at the implementation of computed tomography in the patient care pathway that is outcome focused
Rapid access chest pain clinics The accurate identification of patients with ischaemic heart disease is important because up to 30% of patients presenting with recent-onset angina have a cardiac event within 1 to 2 years [3] and many of these patients may benefit from coronary revascularization [4]
Summary
Rapid access chest pain clinics have facilitated the early diagnosis and treatment of patients with coronary heart disease and angina. Rapid access chest pain clinics The accurate identification of patients with ischaemic heart disease is important because up to 30% of patients presenting with recent-onset angina have a cardiac event within 1 to 2 years [3] and many of these patients may benefit from coronary revascularization [4]. This has led many centres to develop the provision of a rapid access chest pain clinic. A specialist cardiology opinion combined with the resources of a chest pain clinic service would appear to have a higher diagnostic yield for ischaemic heart disease than open-access exercise electrocardiography, and would provide the primary care physician with a firm clinical diagnosis in the majority of cases, and identify those patients requiring further invasive investigation [5]
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