Objective: To conduct a one year follow up study of patients seen In a combined rapid access chest pain, arrhythmia and heart failure clinic. Methods: Local general practitioners, accident and emergency department clinicians and other hospital clinicians were invited to refer patients with a new presentation of chest pain, palpitations and suspected cardiac-induced breathlessness to the rapid access cardiology clinics at Charing Cross Hospital, London, on a one-stop, no appointment basis. Consent to be followed up by a postal questionnaire one year later was sought from all patients attending between 1 November 2002 and 31 October 2003. Results: 1223 patients were seen in the 12 month study period. 940(77%) consented to one year follow up. 216(23%) patients had a diagnosis of definite cardiac, 621(66%) of not cardiac and 103 of possible cardiac disease(11%). 98%of patients diagnosed “not cardiac”did not receive a diagnosis of cardiac disease over the following 12 months. Of patients with diagnosed definite cardiac disease, one year cardiac mortality was 7 of 216(3%), compared with an age-and sex-matched expected cardiac mortality of 0.9%(standardised mortality ratio 3.5, 95%confidence interval(CI)1.4 to 7.2). For patients with an initial diagnosis of possible or not cardiac disease, cardiac mortality at one year was 0.3%compared with an expected cardiac mortality of 0.4%(standardised mortality ratio 0.8, 95%CI 0.1 to 2.8). Conclusions: A rapid access cardiology clinic accurately diagnoses and risk stratifies patients into those with cardiac disease at high risk of cardiac death and those without significant cardiac disease. Methods: Local general practitioners, accident and emergency department clinicians and other hospital clinicians were invited to refer patients with a new presentation of chest pain, palpitations and suspected cardiac-induced breathlessness to the rapid access cardiology clinics at Charing Cross Hospital, London, on a one-stop, no appointment basis. Consent to be followed up by a postal questionnaire one year later was sought from all patients attending between 1 November 2002 and 31 October 2003. Results: 1223 patients were seen in the 12 month study period. 940 (77%) consented to one year follow up. 216 (23%) patients had a diagnosis of definite cardiac, 6% (6%) of not cardiac and 103 of possible cardiac disease (11%). 98% of patients diagnosed “not cardiac” did not receive a diagnosis of cardiac disease over the following 12 months. Of patient s with diagnosed definite cardiac disease, one year cardiac mortality was 7 of 216 (3%), compared with an age-and sex-matched expected cardiac mortality of 0.9% (standardized expected ratio 3.5, 95% confidence interval For patients with an initial diagnosis of possible or not cardiac disease, cardiac mortality at 0.3% compared with an expected cardiac mortality of 0.4% (standardized mortality ratio 0.8, 95% CI 0.1 to 2.8). Conclusions: A rapid access cardiology clinic accurately diagnoses and risk stratifies patients into those with cardiac disease at high risk of cardiac death and those without significant cardiac disease.