Application of the Duke's treadmill score to a rapid access chest pain clinic

In 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.