Kwok Bernard W K, Tang Hak Chiaw, Wee Shiou Liang, Tai Virginia U M, Tan Caren G P, Chua Terrance S J
Department of Cardiology, National Heart Centre, Singapore.
Ann Acad Med Singap. 2008 Feb;37(2):103-8.
Increasing demand for public healthcare and access to specialist care has become a major concern. Characterising the referral pattern to a national centre's cardiology specialist outpatient clinics (SOCs) and the diagnostic outcomes may be useful in formulating referral guidelines to contain rising demand.
A prospective observational followup study was conducted of all consecutive new patient referrals to the cardiology SOCs of the National Heart Centre over a 1-month period. The records of these 1224 patients were reviewed following their first visit and again after 3 months of evaluation and investigation. Patients' demographics, referral sources, indications of referral, risk factors, provisional and final diagnoses were collected. Referrals from the top 2 volume sources (government polyclinics and hospital Emergency Department) accounted for 600 referrals. These subsidised referrals formed the study group for analysis.
The mean age of referred patients was 56 +/- 15.2 years, with equal proportion of males and females. Most patients had known cardiac risk factors of hypertension (53.2%) and hyperlipidaemia (42.3%). Only 23% of referrals had significant cardiac abnormalities. Referrals for typical chest pain derived the highest yield whereas referrals for atypical chest pain, non-cardiac chest pain derived the lowest yield. Referrals for asymptomatic electrocardiogram (ECG) changes (except for atrial flutter/fibrillation) did not yield cardiac abnormalities. Multivariate analysis of chest pain referrals showed typical chest pain and hyperlipidaemia to be statistically significant predictors for coronary artery disease.
Referrals to cardiology outpatient specialist clinics should be based on the presence of patient symptoms, particularly that of typical chest pain. In asymptomatic patients, routine ECG screening did not appear to yield significant cardiac abnormalities.
对公共医疗保健和专科护理的需求不断增加已成为一个主要问题。描述转诊至国家中心心脏病专科门诊（SOCs）的模式以及诊断结果可能有助于制定转诊指南，以控制不断上升的需求。
对国家心脏中心心脏病SOCs在1个月内连续转诊的所有新患者进行前瞻性观察随访研究。在这些患者首次就诊后以及经过3个月的评估和检查后，对其1224例患者的记录进行了复查。收集了患者的人口统计学信息、转诊来源、转诊指征、危险因素、初步诊断和最终诊断。来自转诊量最大的前两个来源（政府综合诊所和医院急诊科）的转诊患者有600例。这些享受补贴的转诊患者构成了研究组进行分析。
转诊患者的平均年龄为56±15.2岁，男女比例相等。大多数患者有已知的心脏危险因素，如高血压（53.2%）和高脂血症（42.3%）。只有23%的转诊患者有明显的心脏异常。典型胸痛的转诊患者诊断阳性率最高，而非典型胸痛、非心脏性胸痛的转诊患者诊断阳性率最低。无症状心电图（ECG）改变（心房扑动/颤动除外）的转诊患者未发现心脏异常。对胸痛转诊患者的多因素分析显示，典型胸痛和高脂血症是冠状动脉疾病的统计学显著预测因素。
转诊至心脏病专科门诊应基于患者症状，尤其是典型胸痛症状。对于无症状患者，常规心电图筛查似乎未发现明显的心脏异常。
