Referral criteria from primary care - stable angina

Urgent hospital assessment and admission should be arranged for people with any symptoms suggesting possible acute coronary syndrome including: (1) (2)

Pain at rest (may occur at night).

Pain on minimal exertion.

Angina that seems to be progressing rapidly despite increasing medical treatment

Refer urgently all people with suspected angina (to be seen within two weeks) to a Rapid Access Chest Pain Clinic for confirmation of the diagnosis and assessment of the severity of coronary heart disease.

Early referral to cardiologists should also be considered in the following patients:

• new onset of chest pain suspected to be ischaemic of origin
• exacerbation of stable angina
• recurrence of old angina
• results of the exercise tolerance test is highly abnormal
• history of myocardial infarction, coronary artery bypass graft, or percutaneous transluminal coronary angioplasty and development of angina
• evidence of previous MI or other abnormality in the initial ECG
• newly diagnosed atrial fibrillation
• cardiac failure and angina
• an ejection systolic murmur suggesting aortic stenosis
• treatment failure despite maximum therapeutic doses of two drugs
  
  

• additional reasons for cardiologist referral include:
  • doubt about the diagnosis of patients with uncertain or atypical symptoms
  • presence of several risk factors or a strong family history "
  • patients wish for an early referral
  • problems with employment, life insurance, or unacceptable interference with lifestyle
  • significant comorbid disease e.g. - diabetes

Note that if suspected unstable angina/myocardial infarction then this requires immediate referral to secondary care.

References

1. Ford TJ, Corcoran D, Berry C. Stable coronary syndromes: pathophysiology, diagnostic advances and therapeutic need. Heart. 2018 Feb

2. Management of stable angina. Scottish Intercollegiate Guidelines Network - SIGN (April 2018).