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Impact of COVID-19 on UK stress echocardiography practice: insights from the EVAREST sites

Echo Research & Practice volume 8, pages 1–8 (2021)Cite this article

Abstract

Introduction Healthcare delivery is being transformed by COVID-19 to reduce transmission risk but continued delivery of routine clinical tests is essential. Stress echocardiography is one of the most widely used cardiac tests in the NHS. We assessed the impact of the first (W1) and second (W2) waves of the pandemic on the ability to deliver stress echocardiography.

Methods Clinical echocardiography teams in 31 NHS hospitals participating in the EVAREST study were asked to complete a survey on the structure and delivery of stress echocardiography as well as its impact on patients and staff in July and November 2020. Results were compared to stress echocardiography activity in the same centre during January 2020.

Results 24 completed the survey in July, and 19 NHS hospitals completed the survey in November. A 55% reduction in the number of studies performed was reported in W1, recovering to exceed pre-COVID rates in W2. The major change was in the mode of stress delivery. 70% of sites stopped their exercise stress service in W1, compared to 19% in W2. In those still using exercise during W1, 50% were wearing FFP3/N95 masks, falling to 38% in W2. There was also significant variability in patient screening practices with 7 different pre-screening questionnaires used in W1 and 6 in W2.

Conclusion Stress echocardiography delivery restarted effectively after COVID-19 with adaptations to reduce transmission that means activity has been able to continue, and exceed, pre-COVID-19 levels during the second wave. Further standardization of protocols for patient screening and PPE may help further improve consistency of practice within the United Kingdom.

Conclusion Stress echocardiography delivery restarted effectively after COVID-19 with adaptations to reduce transmission that means activity has been able to continue, and exceed, pre-COVID-19 levels during the second wave. Further standardization of protocols for patient screening and PPE may help further improve consistency of practice within the United Kingdom.

References

  1. Gates B Responding to Covid-19 - a once-in-a-century pandemic? New England Journal of Medicine 2020 382 1677–1679. (https://doi.org/10.1056/NEJMp2003762)

    Article  CAS  Google Scholar 

  2. Hunter DJ Covid-19 and the stiff upper lip - the pandemic response in the United Kingdom. New England Journal of Medicine 2020 382 e31. (https://doi.org/10.1056/NEJMp2005755)

  3. Public Health England. Coronavirus (COVID-19) in the UK, 2020. (available at: https://coronavirus.data.gov.uk/). Accessed on 24 July 2020.

    Google Scholar 

  4. NHS England. Operating framework for urgent and planned services in hospital settings during covid-19, 2020. (available at: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/05/Operating-framework-for-urgent-and-planned-services-within-hospitals.pdf). Accessed on 24 July 2020.

    Google Scholar 

  5. NHS England. Novel coronavirus (COVID-19) standard operating procedure: community health services, 2020. (available at: https://www.england.nhs.uk/coronavirus/publication/novel-coronavirus-covid-19-standard-operating-procedure-community-health-services/). Accessed on 24 July 2020.

    Google Scholar 

  6. Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, Jain SS, Burkhoff D, Kumaraiah D, Rabbani L, et al. Coronavirus disease 2019 (COVID-19) and cardiovascular disease. Circulation 2020 141 1648–1655. (https://doi.org/10.1161/CIRCULATIONAHA.120.046941)

    Article  CAS  Google Scholar 

  7. Public Health England. Recommended PPE for primary, outpatient, community and social care by setting, NHS and independent sector, 2020. (available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/878750/T2_poster_Recommended_PPE_for_primary__outpatient__community_and_social_care_by_setting.pdf). Accessed on 4 August 2020.

    Google Scholar 

  8. NHS Scotland. Assessing the evidence base for medical procedures which create a higher risk of respiratory infection transmission from patient to healthcare worker, 2020. (available at: https://hpspubsrepo.blob.core.windows.net/hps-website/nss/3055/documents/1_agp-sbar.pdf). Accessed on 4 August 2020.

    Google Scholar 

  9. Bhattacharyya S, Chehab O, Khattar R, Lloyd G, Senior R & British Society of Echocardiography. Stress echocardiography in clinical practice: a United Kingdom National Health Service Survey on behalf of the British Society of Echocardiography. European Heart Journal Cardiovascular Imaging 2014 15 158–163. (https://doi.org/10.1093/ehjci/jet082)

    Article  Google Scholar 

  10. Asher A, Ghelani R, Thornton G, Rathod K, Jones D, Wragg A, & Timmis A UK perspective on the changing landscape of noninvasive cardiac testing. Open Heart 2019 6 e001186. (https://doi.org/10.1136/openhrt-2019-001186)

  11. British Heart Foundation. BHF heart and circulatory diseases in UK statistics - Jul 2020 factsheet, 2020. (available at: https://www.bhf.org.uk/what-we-do/our-research/heart-statistics). Accessed 24 July 2020.

    Google Scholar 

  12. British Society of Echocardiography. Restoration of a stress echocardiography service during the COVID-19 pandemic, 2020. (available at: https://www.bsecho.org/Public/Education/Post-COVID-clinical-guidance/Stress-echo/Public/Education/PC-stressecho.aspx). Accessed on 3 September 2020.

    Google Scholar 

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Authors and Affiliations

  1. Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, UK

    Cameron Dockerill, William Woodward, Annabelle McCourt, Cristiana Monteiro, Elena Benedetto & Paul Leeson

  2. School of Medicine, University of Leeds, Leeds, UK

    Maria Paton

  3. Cardiovascular Physiology, School of Sport and Exercise Sciences, Liverpool, UK

    David Oxborough

  4. North West Anglia NHS Foundation Trust, Bretton Gate, Bretton, Peterborough, Cambridgeshire, UK

    Shaun Robinson

  5. Manchester University NHS Foundation Trust, Wythenshawe Hospital, Wythenshawe, Manchester, UK

    Keith Pearce

  6. King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK

    Mark J. Monaghan

  7. Royal United Hospitals Bath NHS Foundation Trust, Bath, UK

    Daniel X. Augustine

  8. Department for Health, University of Bath, Bath, Somerset, UK

    Daniel X. Augustine

Authors
  1. Cameron Dockerill
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  2. William Woodward
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  3. Annabelle McCourt
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  4. Cristiana Monteiro
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  5. Elena Benedetto
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  6. Maria Paton
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  7. David Oxborough
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  8. Shaun Robinson
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  9. Keith Pearce
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  10. Mark J. Monaghan
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  11. Daniel X. Augustine
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  12. Paul Leeson
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Corresponding author

Correspondence to Paul Leeson.

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Dockerill, C., Woodward, W., McCourt, A. et al. Impact of COVID-19 on UK stress echocardiography practice: insights from the EVAREST sites. Echo Res Pract 8, 1–8 (2021). https://doi.org/10.1530/ERP-20-0043

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  • DOI: https://doi.org/10.1530/ERP-20-0043

Keywords

Echo Research & Practice

ISSN: 2055-0464

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