The Royal Free London (RFL) Suspected Stable Angina Service (SSAS) previously Rapid Access Chest Pain Clinic (RACP) provides cardiology assessments which are usually nurse led, for patients with new onset of exertional chest pain which is suggestive of ischaemic heart disease (IHD).

Patients with existing angina or known IHD and worsening symptoms, who are not under active follow-up by a cardiologist should be referred directly to the general cardiology clinic to avoid delay, as we can no longer internally redirect these patients.

Please ensure they are re-referred back to the cardiology team who have made the original diagnosis or treatment to prevent duplicate testing. 

Clinical contacts

t: 020 7794 0500 x34281 (secretary to CNS team)
t: 020 7794 0500 x39461 (cardiology service manager)

Eligibility Criteria

Inclusions

• New onset of exertional chest pain in the last three months suggestive of stable angina. 
• Patients with significant cardiac risk factors and atypical presentation where CAD cannot be excluded. 
• Males <30 years old or females <40 years old only in exceptional circumstances (e.g. familial hyperlipidaemia). 
• Patients with exertional dyspnoea considered to be an angina-equivalent may be referred only if NT-pro BNP, chest X-ray and lung pathologies have been excluded. (Diabetic patients will be accepted).  
   

Exclusions

• ​​​​​​Patients with suspected acute myocardial infarction or an unstable acute coronary syndrome should be referred directly to A&E.
• Patients with known ischaemic heart disease (CABG/PCI/known angina) will NOT be accepted for SSAC. Refer directly to cardiology to avoid delay. 
• Isolated episodes of chest pain will not be accepted. 
• Patients previously investigated in the last five years with negative investigations for ischaemia or CTCA with non-significant CAD.  
• Patients with palpitations, dizziness or syncope should not be referred. Refer to appropriate cardiology service e.g. cardiac rhythm management and consider holter monitor / echocardiogram in the first instance. 
• Patients will not be accepted for abnormal ECG findings. Refer acute ECG changes directly to A&E. For other non-specific ECG changes, please complete an echocardiogram with onward referral to the relevant team as necessary.
• Patients with non-anginal sounding chest pain should not be referred for reassurance.  
• BP must be below 180mmHg systolic and 90mmHg diastolic. If symptomatic, refer directly to A&E, or in the absence of symptoms, consider optimisation of anti-hypertensive medications or a referral to the complex hypertension clinic.

How to Refer