Amanda Casey
Rapid Access Chest Pain CNS, University Hospital Limerick
Angela Clancy
Rapid Access Chest Pain CNS, University Hospital Limerick
The Rapid Access Chest Pain (RACP) service at University Hospital Limerick (UHL) is celebrating 10 years of providing specialised care to patients presenting with chest pain.
The service is led by Clinical Nurse Specialists Amanda Casey and Angela Clancy, under the clinical governance of Consultant Cardiologist Dr Samer Arnous and is supported by our dedicated Clerical Officer, Diane Spellman.
Rising CVD spurs cardiac care
The RACP service was established in response to the growing number of patients presenting to emergency department with chest pain and the increasing prevalence of cardiovascular disease (CVD). Cardiovascular disease remains one of the leading causes of death worldwide. In Ireland, almost 9,000 people die annually from CVD-related causes, while Central Statistics Office figures show that CVD accounted for 28% of deaths in 2023, making it the country’s second leading cause of death.
Chest pain can have many causes, ranging from relatively benign conditions such as musculoskeletal pain, anxiety and gastrointestinal disorders to potentially life-threatening events including acute coronary syndrome, aortic dissection and pulmonary embolism.
Rapid chest pain pathway
The RACP service provides two referral pathways for UHL patients. Inpatients can receive a same-day review where appropriate, while the outpatient pathway aims to provide a virtual review within 72 hours of discharge and a clinic appointment within two weeks.
During assessment, the Clinical Nurse Specialists take a detailed history and assess cardiovascular risk factors including smoking, cholesterol, blood pressure, family history, body mass index and diabetes. Working alongside senior cardiac clinicians, they determine the appropriate diagnosis, investigations and care plan.
Working alongside senior cardiac clinicians,
they determine the appropriate diagnosis, investigations and care plan
Where required, the service can arrange a range of cardiac investigations, including exercise stress tests, echocardiograms, CT coronary angiograms, diagnostic coronary angiograms, 24-hour blood pressure monitoring and Holter monitoring.
Faster diagnosis and healthier outcomes
Over the past decade, the service has had a positive impact on patient care, supporting the early diagnosis of coronary heart disease, helping to reduce waiting times, avoid unnecessary hospital admissions and expedite discharge with estimated savings of approximately €9.53 million.
While a key objective is to identify or rule out coronary artery disease and determine which patients may require invasive angiography, the service also plays an important role in preventing future cardiovascular events. Through assessment, education and risk-factor modification, the RACP team supports patients in making informed decisions about their health and encourages healthier lifestyles.
