referral criteria from primary care - stable angina

Last reviewed 01/2018

Referral to a cardiologist with patient with angina/suspected angina

• early referral to cardiologists should be considered in the following patients:
  • new onset of chest pain suspected to be ischaemic of origin (1)
  • exacerbation of stable angina (1)
  • recurrence of old angina (1)
  • 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 (2)
  • evidence of previous MI or other abnormality in the initial ECG (3)
  • newly diagnosed atrial fibrillation
  • cardiac failure and angina (2)
  • an ejection systolic murmur suggesting aortic stenosis (3,4)
  • 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 (3)

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

Reference:

• 1.Coventry and Warwickshire University Hospitals (December 2009). Rapid Access Chest Pain Referral Pathway.
• 2 Clinical Knowledge Summaries 2009.Angina - Stable
• 3. Scottish Intercollegiate Guidelines Network (SIGN) 2001. Management of stable angina
• 4. Scottish Intercollegiate Guidelines Network (SIGN) 2007. Management of stable angina