COPs demonstrated a high level of exact diagnostic concordance when compared with discharge diagnosis made by consultant cardiologist, suggesting that COP-led assessments are reliable when working within a clinical pathway.
Key Findings
Results
Overall exact diagnostic concordance between initial COP diagnoses and final discharge diagnoses was 92.7%.
216 out of 233 patients had concordant diagnoses (92.7%).
The 216 exact concordant cases comprised 125 concordant cardiac diagnoses and 91 concordant non-cardiac diagnoses.
Study was retrospective, single-centre, conducted at a UK district general hospital between January and June 2025.
779 cases were screened in total, with 233 patients meeting inclusion criteria following staged exclusions.
Results
COPs achieved near-perfect agreement with consultant cardiologist discharge diagnoses as measured by Cohen's kappa.
Cohen's kappa (κ) was 0.858 (95% CI 0.789 to 0.927), indicating 'almost-perfect agreement'.
Overall classification accuracy for identifying ACS was 93.6%.
This level of agreement was achieved in an out-of-hours setting without resident on-call cardiology registrars.
Results
COP sensitivity for identifying acute coronary syndrome (ACS) was 96.0%.
Sensitivity for ACS identification was 96.0%.
Specificity was 92.4%.
Positive predictive value was 85.9%.
Negative predictive value was 98.0%.
Results
The 17 discordant diagnostic cases were not associated with any delayed escalation, investigation, or management.
17 out of 233 cases had discordant diagnoses between COP initial assessment and final discharge diagnosis.
None of the discordant cases resulted in delayed escalation, investigation, or management.
This finding suggests that diagnostic discordance did not translate into patient safety events in this cohort.
Background
Cardiac outreach practitioners (COPs) are increasingly used in UK district general hospitals that lack resident overnight cardiology registrars.
Many district general hospitals (DGHs) in the UK do not have resident on-call cardiology registrars overnight.
COPs provide specialist input for patients presenting with suspected cardiac events out of hours.
This study is described as evaluating 'exact diagnostic concordance' between COP initial working diagnoses and final discharge diagnoses.
What This Means
This research evaluated whether specialist cardiac nurses known as cardiac outreach practitioners (COPs) can accurately assess patients with suspected heart problems during out-of-hours periods in a UK district general hospital. Many UK hospitals do not have a specialist heart doctor (cardiology registrar) available overnight, so COPs increasingly step in to provide initial assessments. The study compared the initial diagnoses made by COPs with the final diagnoses made by consultant cardiologists at the point of patient discharge, across 233 patients seen between January and June 2025.
The findings showed that COPs agreed with the final consultant diagnosis in 92.7% of cases, and their ability to correctly identify or rule out acute coronary syndrome (a serious heart condition including heart attacks) was particularly strong — they correctly identified 96% of true ACS cases and correctly ruled it out in 98% of cases where it was not present. In the small number of cases where the COP's initial diagnosis differed from the final discharge diagnosis, none resulted in any delay in treatment or investigation for the patient.
This research suggests that when COPs work within a defined clinical pathway, their diagnostic assessments are highly reliable and closely match those of consultant cardiologists. This has practical implications for how UK hospitals can safely staff overnight cardiac services, potentially allowing COPs to provide effective specialist input in settings where overnight physician cover is not available.
Shaw C, Roberts K, McDonagh K, Frosdick A, Thomas M, Robson F, et al.. (2026). Maintaining quality out-of-hours in an acute cardiology service in a UK primary PCI centre.. Open heart. https://doi.org/10.1136/openhrt-2026-004310