The rationale is clear, but evidence is needed

Angina is the cinderella to acute coronary syndromes, with uncertainty about how well and consistently patients are investigated and treated by the NHS. The new national service framework standard in England for patients with angina is investigation and treatment to relieve pain and reduce coronary risk,1 and the rapid access chest pain clinic is the preferred way of delivering such care. 2 3 The goal was to have 50 such clinics by April 2001, but there are already 100, with nationwide rollout gathering pace. What is the rationale for such clinics and do they work?

Patients presenting for the first time to their general practitioner with suspected angina can now be assessed by a specialist through a rapid access chest pain clinic. Patients with suspected acute coronary disease should still be sent direct to the casualty department; if they are then diagnosed as having exertional angina they too can be referred to the rapid access clinic, rather than a traditional outpatient clinic or back to general practice. There is observational evidence that these rapid access clinics reduce admissions.4 Thus they will close the loop between community and hospital for cardiac chest pain, whatever …