Dockerill Cameron, Woodward William, McCourt Annabelle, Monteiro Cristiana, Benedetto Elena, Paton Maria, Oxborough David, Robinson Shaun, Pearce Keith, Monaghan Mark J, Augustine Daniel X, Leeson Paul
Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.
School of Medicine, University of Leeds, Leeds, UK.
Echo Res Pract. 2021 Mar;8(1):1-8. doi: 10.1530/ERP-20-0043.
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.
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.
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.
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.
新冠疫情正在改变医疗服务的提供方式以降低传播风险，但常规临床检查的持续开展至关重要。负荷超声心动图是英国国家医疗服务体系（NHS）中使用最广泛的心脏检查之一。我们评估了疫情的第一波（W1）和第二波（W2）对负荷超声心动图检查能力的影响。
参与EVAREST研究的31家NHS医院的临床超声心动图团队被要求在2020年7月和11月完成一项关于负荷超声心动图检查的结构、开展情况及其对患者和工作人员影响的调查。将结果与2020年1月同一中心的负荷超声心动图检查活动进行比较。
7月有24家完成了调查，11月有19家NHS医院完成了调查。据报告，W1期间进行的检查数量减少了55%，W2期间恢复并超过了疫情前的水平。主要变化在于负荷检查的方式。70%的机构在W1期间停止了运动负荷检查服务，而W2期间这一比例为19%。在W1期间仍采用运动负荷检查的机构中，50%的工作人员佩戴FFP3/N95口罩，W2期间降至38%。患者筛查做法也存在显著差异，W1期间使用了7种不同的预筛查问卷，W2期间为6种。
新冠疫情后，负荷超声心动图检查在采取了降低传播风险的调整措施后有效重启，这意味着检查活动得以继续开展，并且在第二波疫情期间超过了疫情前的水平。进一步规范患者筛查和个人防护装备（PPE）的方案可能有助于进一步提高英国国内检查操作的一致性。
