Application of the Dukes Treadmill Score to a Rapid Access Chest Pain Clinic.

Abstract

n an observational study, we sought to determine the effect of applying the Duke’s treadmill score on patient assessment and prioritisation to coronary angiography waiting lists within a rapid access chest pain clinic in a UK district general hospital. After attending the rapid access chest pain clinic, patients requiring subsequent coronary angiography were placed on either an urgent or a routine waiting list. We determined the number of patients subsequently shown to have severe coronary artery disease (left main stem or three-vessel disease) in both waiting lists. We then assessed the effect of applying the Duke’s treadmill score retrospectively on these patients to produce regraded waiting lists (urgent and routine); these were compared with the actual lists generated clinically. The actual urgent list had 43/111 (39%) patients with severe disease; the actual routine list had 28/98 (29%) patients with severe disease (p=NS). Application of the Duke’s treadmill score to produce re-graded lists reduced the total number of patients on the urgent list from 111 to 68. Thirty-three of 68 (49%) patients on the Duke’s treadmill score urgent list had severe disease compared to 43/111 (39%) on the actual urgent waiting list. Specificity for allocating patients with severe disease to the urgent waiting list improved from 50% to 75% by application of the Duke’s treadmill score compared with the clinically generated list. Thus, the Duke’s treadmill score could be used in a rapid access chest pain clinic to prioritise patients objectively for cardiac catheterisation in a resource-limited system.