Can clinical assessment of chest pain be made more therapeutic?

We describe the referral and management of consecutive patients attending a cardiac service with the presenting complaint of chest pain. Of 610 consecutive new referrals to five Oxford cardiac clinics over 12 weeks, 202 had chest pain as the presenting complaint: 91 (45%) angina, 101 (50%) non-cardiac chest pain, 8 (4%) both and 2 (1%) uncertain diagnosis. Information in clinic letters was sometimes ambiguous and contradictory and suggested a lack of precise information to patients. Patients with non-cardiac chest pain often had long histories, including considerable previous use of services and specialist investigations. There were delays in referral and assessment of patients. There are opportunities for simple changes in assessment procedures which might have substantial advantages for outcome and resource: (i) more detailed referral information from general practitioners, with an explicit statement of the reasons for referral; (ii) minor modifications to augment the assessment by provision of unambiguous information to patients and primary care at discharge.