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Contrast echo image of the heart.

A collaboration between the Cardiovascular Clinical Research Facility and the British Society of Echocardiography has uncovered the impact of the COVID-19 pandemic on the provision of stress echocardiography across the NHS.

 Stress echocardiography is a commonly used, non-invasive test used to assess whether a patient has coronary artery disease. The test involves capturing ultrasound images of the heart when the heart rate is increased (for example, by exercise or following the infusion of a drug called dobutamine that increases heart rate). The work, led by PhD student Cameron Dockerill, evaluated the stress echocardiography services of 24 hospitals across the UK involved with the EVAREST study during the first and second waves of the pandemic.

The study, published in Echo Research and Practice, found that the number of stress echocardiograms performed during the first wave dropped by 55% compared to pre-COVID rates, with three centres stopping the service completely. What’s more, there was variation in how different hospitals chose to run their stress echocardiography clinics, with some sites choosing to only perform dobutamine stress echocardiography to reduce the risk of disease transmission through aerosol generation during exercise. The measures to mitigate the spread of infection, such as the use of personal protective equipment or patient symptom screening questionnaires, also varied between centres.

However, during the second wave, all centres that responded to the study questionnaire had managed to resume their stress echocardiography services, and were performing more stress echocardiograms than they were before the pandemic hit. However, most centres were still only using dobutamine. “This shows how quickly the hospitals adapted to minimise the risk to their patients and staff to get this vital clinical service up and running again” said Annabelle McCourt, CCRF Clinical Research Assistant working on the EVAREST/BSE NSTEP collaboration.

Cameron Dockerill, the first author of the paper, said: “This paper highlights the resilience of stress echocardiography staff, who were able to quickly adapt to new requirements and protective measures following the first wave of the pandemic. Restoring stress echocardiography services to above and beyond the pre-pandemic rates, during the second wave, was a fantastic achievement.”

The collaboration between the Cardiovascular Clinical Research Facility and British Society of Echocardiography will provide a National Review of Stress Echo Practice (NSTEP) to examine how stress echocardiography is used in real-world practice across the NHS. This is the first research output of this collaboration.

Dr. Daniel Augustine, Chair of the BSE NSTEP committee, said: “This is really important and timely work which demonstrates how Trusts of different sizes have adapted to increase throughput of stress echocardiograms during the second COVID-19 wave. This work wouldn’t have been possible in the short timeline needed if it had not been for the established network of UK NHS Trusts who participate in the EVAREST project. The BSE are delighted to be working with Professor Leeson and the EVAREST study team to move the BSE NSTEP project forwards”.

Read the full paper.