Optimising chest pain pathways that ensure earlier access to definitive care for patients in remote and rural communities

Chest pain is a common symptom for many serious health conditions and is the leading cause of ambulance attendances, with and over 470,000 presentations to Australian Emergency Departments (EDs) every year. We have demonstrated that more than one quarter (26%) of all chest patients live in remote and rural communities and unfortunately have disparate outcomes compared to their metropolitan counterparts due in part to their distance from and access to definitive care, in addition to limited care capability in many local regional hospitals. In Victoria, mean annual costs for chest pain transported via ambulance from remote/rural communities is ~$100 million. Current prehospital practice is that all patients with chest pain are transported to the nearest hospital ED for further assessment regardless of hospital capabilities. However, 50% of patients are found to be at low-risk and are ultimately discharged from ED without a specific diagnosis, at an annual cost of up to $35 million in remote/rural communities. Chest pain, therefore, represents a major public health concern for remote and rural patients and is a substantial time and cost burden.