Acute Chest Pain

Acute Chest Pain accounts for more than 700,000 visits to A&E departments in the UK per year in England and Wales.

TOHETI aims to improve the management of patients that attend A&E with an episode of acute chest pain, where a heart attack is ruled out through initial tests including heart trace electrocardiograph (ECG) and blood tests including troponin. Despite ruling out a heart attack in A&E, upon discharge, sometimes concerns remain regarding the possibility of significant underlying coronary artery disease (narrowing(s) of the heart blood vessels) with associated risk of a potential future heart attack.

Upon discharge, sometimes concerns remain high regarding the possibility of significant underlying coronary artery disease (narrowing(s) of the heart blood vessels) and resulting risk of a potential future heart attack. Currently these patients who have been discharged from A&E are referred to their GP to be subsequently referred onwards to a cardiology clinic, if deemed appropriate.

Previously a proportion of these patients who were discharged from A&E could not be referred directly to the cardiology clinic. They had to be referred back to their GP and their GP would subsequently refer onwards to the cardiology clinic. This process led to inevitable delays in those patients receiving eventual appointments for the cardiology clinic.

In order to address this, a Hot Chest Pain Clinic has been set up at Guy’s and St Thomas’, where patients can be directly referred to from A&E, depending on concerns regarding the risk of the presence of significant underlying coronary artery disease.

TOHETI aims to evaluate whether the direct referral process, along with the use of the non-invasive imaging techniques of Computed Tomography Coronary Angiography (CTCA) and Cardiac Magnetic Resonance (CMR), in patients referred to the Hot> Chest Pain Clinic contributes to a quicker and more efficient diagnosis in ruling in or ruling out Coronary Artery Disease. 150 patients are already recruited into the study , and the study is still recruiting!

Furthermore in a separate study named the PROTECCT Trial, TOHETI aims to evaluate whether the use of CTCA leads to a reduction in the hospital length of stay of acute chest patients presenting to A&E in whom a heart attack can neither be confirmed nor ruled out. Over 120 participants are already recruited into the study and the study is still recruiting!

Chest Pain