The eChestPain tool, a digital chest pain assessment tool developed by clinicians, has been shown to support investigation triage within Rapid Access Pain Clinics (RACPCs) in patients with suspected stable coronary artery disease. The multi-centre service evaluation of eChestPain is being presented at the British Cardiovascular Society’s annual conference in Manchester.
Coronary artery disease (CAD) is a major cause of death in the UK and worldwide. Referrals to the NHS’ Rapid Access Pain Clinics for suspected CAD have been on the rise, but with investigation strategies and pathways varying from clinic to clinic, and the rising costs for diagnosis, these services have been under strain.
A multi-centre team of cardiology clinicians have designed, developed and evaluated a digital chest pain assessment tool to support decision making, named eChestPain. The clinicians have tested the tool across several RACPCs in East of England and Southeast London. They have looked at feasibility, pathway concordance, safety, and service impact across the RACPC where the tools were tested – a total of 4 RACPCs.
Being a digital tool, adult patients who were referred for suspected stable chest pain were asked to complete the eChestPain assessment before their clinical consultations, answering questions about their symptoms. Based on and aligned with NICE guidance, the eChestPain tool was trained to capture structured symptom data, generate an angina categorisatision, and make recommendations for clinical investigation for each patient. Clinicians were blinded to the digital tool’s recommendations until they completed the routine clinician assessment with the patient. Then, study authors looked at the concordance between clinicians-selected investigations and app-generated recommendations for investigation, and assessed these descriptively. Finally, researchers also looked at patient and staff feedback, to evaluate usability and the impact on workflow.
A total of 65 patients were evaluated with eChestPain. The tool recommended CT coronary angiography (CTCA), which is a non-invasive heart imaging test that uses CT scanning and a contrast dye to create a 3D image of the arteries of your heart, more frequently than the standard clinical assessment (25 vs 20 cases). It also made fewer recommendations for invasive angiography (0 vs 4 cases), and slightly fewer ‘no investigation recommended’ outcomes (12 vs 13 cases) than the clinician assessment.
Dr Yousaf Bhatti, one of the study authors, said: “The eChestPain app eliminated invasive angiography recommendations and directed more patients towards CTCA, which is in alignment with the guidelines and would decrease invasive testing burden. Further, the average wait time from referral to clinic appointment resulting in investigations and decision-making of the standard pathway is 11 days. Automation of the referral triage and first-appointment data capture through the eChestPain pathway would yield a potential timesaving equivalent to approximately 0.69 FTE staff. Our tool demonstrates high patient and staff acceptability, and substantial potential for service-level efficiencies.”
Dr Rajiv Sankaranarayanan, on behalf of the British Cardiovascular Society, said: “This study highlights the potential role for clinician-designed digital tools such as “eChestPain” to support more standardised, guideline-aligned assessment of patients in stable chest pain pathways, with a greater emphasis on non-invasive investigation strategies such as CT coronary angiography and where appropriate, fewer recommendations for invasive angiography. The findings are encouraging and suggest that digital symptom assessment platforms may help improve pathway efficiency, consistency and resource utilisation within increasingly pressured Rapid Access Chest Pain Clinics.
“However, this remains a relatively small real-world study, and larger prospective studies across broader, more diverse populations are needed to fully evaluate diagnostic accuracy, clinical outcomes, cost-effectiveness, and patient safety before widespread adoption can be recommended. Importantly, digital tools should be viewed as decision-support systems rather than replacements for personalised clinical judgement. A suitably trained clinician must remain an integral part of the pathway to interpret findings within the wider clinical context, ensure patient-centred holistic decision making, and safeguard against the risks of over-reliance on algorithm-driven recommendations.”
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Note to editors:
If using this study, please ensure you mention that the study was presented at the British Cardiovascular Society’s Annual Conference.
The conference will be held at Manchester Central from 1 to 3 June 2026, and is attended by UK and international cardiologists and healthcare professionals.
About the BCS
The British Cardiovascular Society is a membership association, with a pivotal role to play in the delivery of cardiovascular health across the UK, supporting and representing all those working in the fields of cardiovascular care and research. We do this through our educational activities, our key roles in the organisation of cardiology training and production of clinical guidelines, and our input into national policy.
We currently have over 3,000 members, including consultant cardiologists, resident cardiologists, nurses, GPs with a special interest in cardiology, non-clinical scientists and technicians.
For further information about the charity, visit britishcardiovascularsociety.org.uk.