Palpitation referrals from primary care to a secondary care cardiology outpatient clinic: assessing adherence to guidelines

Susil Pallikadavath, Roshan Patel, Rishi Sarania, Talal Ahmad, Zakariyya Vali, Ngianga Ii Kandala, Alastair Sandilands

Research output: Contribution to journalArticlepeer-review


Background and aims: Palpitations are a common presentation in primary care. Guidelines have been developed to identify patients with palpitations who require further assessment by a cardiologist in secondary care. However, patients that do not meet guideline thresholds for referrals are still referred to secondary care services. This audit evaluated the adherence to referral guidelines at our trust and assessed the characteristics of patients who were referred appropriately versus those referred without meeting guideline referral thresholds (inappropriate referral). 

Results: Palpitation referrals to a single cardiology outpatient clinic were assessed (n = 66). Half the patients referred for palpitations were referred inappropriately (n = 34, 51.5%). Patients referred inappropriately were more likely to have a benign diagnosis after assessment (91.2%). These patients also had significantly fewer investigations [mean difference of 1.1 (confidence interval: 0.6-1.6)]. Specialist investigations, such as cardiac event recorders (P < 0.05) and cardiac magnetic resonance imaging (P < 0.05) were less likely to be used in inappropriately referred patients. 

Conclusions: The results from this audit provide early evidence that there are a significant number of patients who are being referred that could be managed in primary care. Further studies are needed to confirm our findings in larger cohorts and to establish the underlying reasons for inappropriate referrals.

Original languageEnglish
Pages (from-to)127-131
Number of pages5
JournalFamily Practice
Issue number2
Early online date12 Sept 2020
Publication statusPublished - 1 Apr 2021


  • Adult
  • cardiologists
  • humans
  • physicians primary care
  • quality improvement
  • secondary care


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