• P A Scott, P Appleford, T G Farrell, and N P Andrews.
• Department of Cardiology, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK.
• Postgrad Med J. 2010 Jan 1; 86 (1011): 3-7.

ObjectiveTo investigate the role of a nurse-led clinic in the assessment of patients with palpitations.DesignProspective descriptive study.SettingNurse-led palpitations clinic in a UK district general hospital.ParticipantsPatients referred from primary care or the emergency department with palpitations.MethodsReferral letters were screened, and only patients without high-risk features or a documented arrhythmia were diverted to the palpitations clinic. Patients were evaluated using a protocol. All patients had an ECG and ambulatory ECG monitoring and were discussed with a cardiologist.ResultsOver 15 months, 389 patients were seen. The mean time from referral to assessment was 38 days (range 3-142). The most common diagnoses were symptomatic extrasystoles (42%) and sinus rhythm (22%). Significant arrhythmias were diagnosed in 15% (atrial fibrillation/flutter, 8%; supraventricular arrhythmias, 6%). Only 52 (13%) were subsequently referred to a cardiologist, including 20 with high-risk features. These 20 patients waited on average an additional 70 days to be seen by a cardiologist compared with patients who were seen directly by a cardiologist after referral by primary care or the emergency department.ConclusionsFor low-risk patients, a nurse-led palpitations clinic may provide a viable alternative to the traditional cardiology outpatient service. Despite attempts to exclude them, some high-risk patients were seen. This was unforeseen and led to a clinically important delay in their appropriate assessment. Hence, before adopting a nurse-led palpitations service, a rigorous pathway for the early assessment of high-risk patients needs to be agreed.

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