{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T15:29:14Z","timestamp":1776439754292,"version":"3.51.2"},"reference-count":24,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"unspecified","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Scottish Government Heart Disease Action Plan"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,2,24]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rapid access chest pain (RACP) clinics are designed to expedite cardiac assessment, but current pathways cause delays due to sequential consultations and testing. This pilot evaluated a novel direct-to-CT coronary angiography (CTCA) pathway to test the hypothesis that a \u2018test-first\u2019 model would reduce the time to diagnosis and clinic utilisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a prospective single-centre pilot of consecutive primary care referrals to an RACP service (June 2024\u2013January 2025). Eligible patients with suspected anginal symptoms, no known coronary artery disease (CAD) and no contraindications to CTCA were offered an opt-in to a direct-to-CTCA pathway. CTCA was performed using a prospective single-heartbeat acquisition. The primary outcome was referral-to-diagnosis interval. Secondary outcomes included need for face-to-face consultation, further investigations, incidental findings and theoretical cost savings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>149 patients (mean age 57\u00b19 years, 34% female) underwent CTCA. Median referral-to-diagnosis interval was 29 days (IQR 21\u201341)\u2009vs 88 days (IQR 84\u2013101) in the conventional pathway. CTCA revealed no or mild CAD in 104 (70%) patients; only 47 (32%) required subsequent face-to-face review. Follow-up testing included exercise ECG (17%), echocardiography (8%) and invasive coronary angiography (7%). Incidental findings were uncovered in 30%, with 3% leading to specialty referral. An estimated 102 outpatient visits were avoided, with a cost avoidance estimate of \u00a332 620 per year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A direct-to-CTCA pathway for patients with suspected cardiac chest pain is feasible, reduces time to diagnosis and aligns with National Institute for Health and Care Excellence guidelines. The pathway enables early CAD exclusion in most patients, reduces unnecessary clinic visits and optimises resource use without compromising diagnostic quality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003948","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T14:35:11Z","timestamp":1776436511000},"page":"e003948","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Direct access CT coronary angiography in patients referred with suspected cardiac chest pain: a novel patient pathway"],"prefix":"10.1136","volume":"13","author":[{"given":"Faheem","family":"Ahmad","sequence":"first","affiliation":[{"name":"Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK"},{"name":"School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2380-862X","authenticated-orcid":false,"given":"Jessica","family":"Galvin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy","family":"Cruickshanks","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Radiology, Golden Jubilee National Hospital, Clydebank, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Hunter","sequence":"additional","affiliation":[{"name":"Department of Radiology, Golden Jubilee National Hospital, Clydebank, 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UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth","family":"Mangion","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK"},{"name":"School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK"},{"name":"Department of Radiology, Golden Jubilee National Hospital, Clydebank, 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angiography in the National Institute for Health and Care Excellence (NICE) guideline (CG95) for the investigation of chest pain of recent onset","volume":"12","author":"Kelion","year":"2018","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"2026041707350628000_13.1.e003948.6","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/91.5.333"},{"key":"2026041707350628000_13.1.e003948.7","doi-asserted-by":"crossref","DOI":"10.1136\/openhrt-2014-000151","article-title":"Implementation of NICE Clinical Guideline 95 for assessment of stable chest pain in a rapid access chest pain clinic reduces the mean number of investigations and cost per patient","volume":"2","author":"Lee","year":"2015","journal-title":"Open Heart"},{"key":"2026041707350628000_13.1.e003948.8","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1097\/RCT.0000000000000428","article-title":"Volumetric Single-Beat Coronary Computed Tomography Angiography: Relationship of Image Quality, Heart Rate, and Body Mass 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Initial Patient Experience With a New Computed Tomography Scanner","volume":"40","author":"Latif","year":"2016","journal-title":"J Comput Assist Tomogr"},{"key":"2026041707350628000_13.1.e003948.9","doi-asserted-by":"crossref","DOI":"10.15420\/ecr.2019.14.2","article-title":"Latest Advances in Cardiac CT","volume":"15","author":"Heseltine","year":"2020","journal-title":"Eur Cardiol"},{"key":"2026041707350628000_13.1.e003948.10","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2003.027599"},{"key":"2026041707350628000_13.1.e003948.11","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmi124"},{"key":"2026041707350628000_13.1.e003948.12","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-065622","article-title":"Process modelling of NHS cardiovascular waiting lists in response to the COVID-19 pandemic","volume":"13","author":"Catsis","year":"2023","journal-title":"BMJ Open"},{"key":"2026041707350628000_13.1.e003948.13","doi-asserted-by":"publisher","DOI":"10.1111\/codi.13667"},{"key":"2026041707350628000_13.1.e003948.14","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.jcct.2022.07.002","article-title":"2.0 - 2022 Coronary Artery Disease-Reporting and Data System: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR), and the North America Society of Cardiovascular Imaging (NASCI)","volume":"16","author":"Cury","year":"2022","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"2026041707350628000_13.1.e003948.15","unstructured":"Jones KC , Weatherly H , Birch S , et al . Unit costs of health and social care 2024 manual. 2025. Available: https:\/\/www.pssru.ac.uk\/unitcostsreport\/ [Accessed 11 Jun 2025]."},{"key":"2026041707350628000_13.1.e003948.16","doi-asserted-by":"crossref","DOI":"10.1007\/s11886-016-0718-9","article-title":"Coronary CT Angiography as a Diagnostic and Prognostic Tool: Perspective from a Multicenter Randomized Controlled Trial: PROMISE","volume":"18","author":"Bittner","year":"2016","journal-title":"Curr Cardiol Rep"},{"key":"2026041707350628000_13.1.e003948.17","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/S0140-6736(24)02679-5","article-title":"Coronary CT angiography-guided management of patients with stable chest pain: 10-year outcomes from the SCOT-HEART randomised controlled trial in Scotland","volume":"405","author":"Williams","year":"2025","journal-title":"Lancet"},{"key":"2026041707350628000_13.1.e003948.18","doi-asserted-by":"crossref","unstructured":"Shawki M , Azzopardi R , Al-Fiadh H , et al . 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