Chest Pain Centers
|What Is A Chest Pain Clinic?
Chest Pain Clinics or Centers (CPCs) are specialist units in hospitals which deal specifically with patients experiencing chest pain (they are known as Rapid Access Chest Pain Clinics in the United Kingdom). They were first introduced in the 1980s as a way to reduce deaths among heart attack patients by providing specialist medical care and rapid treatment including drugs and cardiac surgery. Since then, they have evolved and now also manage low-risk patients who are recommended by their family doctor for heart disease testing and monitoring. In the United States hospitals apply for accreditation from the Society of Chest Pain Centers (SCPCP) in order to validate their CPC services. The accreditation process is rigorous and hospitals are assessed for their ability to diagnose and treat patients quickly. Currently there are 400 accredited CPCs in the US, representing only about 10 percent of all hospitals.
The primary goal of a CPC is to reduce the time it takes for a heart attack patient to be diagnosed and treated once they arrive at the clinic door. This is known as 'door-to-balloon time'. Every heart attack is a race against time, with each passing minute the heart muscle is damaged further unless blood flow is restored. Literally, time is muscle. In CPCs the treatment process is highly streamlined, starting from when the patient arrives at the clinic ('door') to the start of treatment ('balloon' – this refers to coronary angioplasty, considered the gold standard of treatment for heart attacks which involves inflating a small balloon in the blocked arteries to restore blood flow). The American Heart Association and the American College of Cardiology have developed national guidelines which call for hospitals providing angioplasty facilities to offer a door-to-balloon time of less than 90 minutes. Many CPCs can do this in 60 minutes. Another goal is to provide specialized observation areas where patients can rest and be closely monitored if it is not clear if they are having a heart attack or another coronary event. This ensures that patients are not sent home too early nor are they needlessly admitted to coronary care units (CCUs) in the main hospital. When a patient arrives displaying heart attack symptoms they will be physically examined and given aspirin therapy. They receive an electrocardiogram test (ECG) and the results will be analyzed within 10 minutes. This diagnostic test can detect injury to the heart and determine if angioplasty is needed. If it is, it will be initiated within 30 minutes.
Although high risk patients were initially the focus of CPCs, most now offer services to low risk patients in the diagnosis and management of coronary heart disease (CHD). The aim is to reduce the numbers of patients who unnecessarily arrive in emergency departments with symptoms of heart disease. In other words CPCs are like a one-stop shop for both emergency and non-emergency heart problems and chest pain. CPCs offer highly specialized diagnostic tests which can diagnose heart problems that your family doctor may suspect but for which he is not equipped to diagnose. Doctors at the CPC may ask you to wear a Holter Monitor for a period of 24-48 hours to monitor your heart's activity. If this does not reveal anything a treadmill stress test will be organized. If the result is negative no further follow-up is usually necessary. If it is positive, you may be admitted for further evaluation including possibly heart catheterization (coronary angiography) and/or CT scans.
CPCs can vary in physical structure - some are self-contained buildings or units within hospital grounds while others are more 'virtual' based. A virtual unit will exist in a hospital as a team of well-rehearsed and skilled personnel (emergency doctors, cardiologists, specialist nurses) who coordinate within specified processes. They do not necessarily work in a self-contained building or rooms but are rather part of the general hospital. The majority of CPCs in America are virtual units. To locate a CPC near you, visit: www.scpcp.org
If you suffer from CHD, maybe you have been diagnosed with stable angina or experience regular chest pain, then it is worth being prepared for an emergency:
• Find out where your nearest accredited CPC is located and keep their phone number easily accessible.
|Related Articles on Rapid Response Chest Pain Centers
For more on surviving cardiac episodes, see the following:
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