{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:49:16Z","timestamp":1785851356224,"version":"3.56.0"},"reference-count":8,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Suspected cardiac chest pain is a common cause for hospital admission. In busy acute NHS hospitals, patients with suspected cardiac chest pain, normal Troponin levels, and no evidence of acute coronary syndrome are often admitted for invasive angiography or CT coronary angiography (CTCA). This has a significant impact on the length of stay, patient flow, and bed capacity. A timely ambulatory pathway for these patients to undergo urgent outpatient CTCA would avoid admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>AIMS<\/jats:title>\n                    <jats:p>The aim was to design an ambulatory pathway for rapid investigation of patients with troponin\u2010negative chest pain, as a safe alternative to admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A trustwide guideline was implemented, which emphasized the use of the heart score to risk\u2010stratify patients, and determine suitability for referral to our new service. Those scoring 4\u22126 were deemed appropriate for the pathway and returned within 96\u2009h to undergo CTCA, then attend the chest pain hot clinic for review. In the original HEART pathway trial, these \u201cmoderate risk\u201d patients were admitted.<\/jats:p>\n                    <jats:p>A unique feature of the pathway was the agreement for non\u2010cardiologists to book the CTCA directly, without cardiology input. This facilitated a very short time to diagnosis from the point of discharge, when compared to similar \u201crapid access chest pain\u201d pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 349 patients were reviewed in the hot clinic between July 4, 2024, and December 31, 2024. Of these, 222 met the referral criteria and were included in the per\u2010protocol analysis. A CTCA was performed for 215 patients, with a minority having a valid contraindication. This alone was sufficient to exclude obstructive coronary disease in 99 of those scanned (44.1%). After completion of the investigation, 87 patients (39.2%) received a final diagnosis of angina, whilst 50 patients (22.5%) had coronary disease significant enough to proceed directly to revascularization.<\/jats:p>\n                    <jats:p>With regards to safety outcomes, 20 patients (9.0%) were admitted from the clinic, and there was only one case of a cardiovascular\u2010related admission prior to the appointment (0.4%), with no associated mortality after 6 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our center's experience demonstrates the feasibility and safety of managing patients presenting with moderate risk chest pain via an urgent ambulatory care pathway. There are significant benefits to this strategy relating to admission avoidance, and our low adverse event rate suggests that this is a safe model when compared to inpatient investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70780","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:15:07Z","timestamp":1785849307000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrating HEART Score and Early CT Coronary Angiography in a Chest Pain Hot Clinic\u2014A Safe Alternative to Inpatient Care From UK Tertiary Center Experience"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8310-1054","authenticated-orcid":false,"given":"Sonny","family":"Harvey","sequence":"first","affiliation":[{"name":"The Southwest Cardiothoracic Centre University Hospitals Plymouth Devon UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazem","family":"Bashiti","sequence":"additional","affiliation":[{"name":"The Southwest Cardiothoracic Centre University Hospitals Plymouth Devon UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5321-4377","authenticated-orcid":false,"given":"Ayman","family":"Helal","sequence":"additional","affiliation":[{"name":"The Southwest Cardiothoracic Centre University Hospitals Plymouth Devon UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerron","family":"Glean","sequence":"additional","affiliation":[{"name":"The Southwest Cardiothoracic Centre University Hospitals Plymouth Devon UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preethii Sasikala","family":"Palanivel","sequence":"additional","affiliation":[{"name":"The Southwest Cardiothoracic Centre University Hospitals Plymouth Devon UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjana","family":"Harish","sequence":"additional","affiliation":[{"name":"The Southwest Cardiothoracic Centre University Hospitals Plymouth Devon UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shankar","family":"Sangaraju","sequence":"additional","affiliation":[{"name":"The Southwest Cardiothoracic Centre University Hospitals Plymouth Devon UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"issue":"22","key":"e_1_2_11_2_1","first-page":"e368","article-title":"2021 AHA\/ACC\/ASE\/CHEST\/SAEM\/SCCT\/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"144","author":"Gulati M.","year":"2021","journal-title":"Circulation"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.21037\/jlpm-22-64"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.14740\/cr1432"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/circoutcomes.114.001384"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2006.100248"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2022.07.002"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-025-04875-6"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2023.06.419"}],"container-title":["Catheterization and Cardiovascular 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