Johnson Casey L, Krasner Samuel, Woodward William, Mao Emma, McCourt Annabelle, Dockerill Cameron, Balkhausen Katrin, Chandrasekaran Badrinathan, Kardos Attila, Sabharwal Nikant, Firoozan Soroosh, Sarwar Rizwan, Senior Roxy, Sharma Rajan, Wong Kenneth, Augustine Daniel X, Paton Maria, O'Driscoll Jamie, Oxborough David, Pearce Keith, Robinson Shaun, Willis James, Leeson Paul
Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.
Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Eur Heart J Cardiovasc Imaging. 2025 Jun 30;26(7):1099-1106. doi: 10.1093/ehjci/jeaf099.
To assess the real-world impact of updated clinical guidelines and literature on the management of patients undergoing stress echocardiography for the assessment of inducible ischaemia across a national health service.
A total of 13 819 patients from 32 UK hospitals, referred for stress echocardiography between 2015 and 2023, were analysed across two phases: phase 1 (2015-2020) and phase 2 (2020-2023). Follow-up data for 1 year was available for 4920 participants through NHS Digital. Patients in phase 2 were younger and presented with a higher cardiovascular risk profile, although sex distribution remained similar across phases. There was an observed reduction in invasive angiography referrals within 1 year following a positive stress echocardiogram (P < 0.01), which appeared to be attributed to changes in the management of patients with moderate ischaemia (3-4 segments; P < 0.01). For those who did receive invasive assessment, there were no changes in intervention rate (P = 0.27), regardless of ischaemic burden. This trend was most evident in centres performing a higher volume of stress echocardiograms.
Coronary disease management pathways have changed within the UK and fewer patients with moderate ischaemia are undergoing invasive coronary angiography. However, coronary intervention rates are unchanged, suggesting that stress echocardiography is being used to improve patient selection for invasive procedures while minimizing unnecessary referrals. Future work will assess if this reduction in angiography referrals is maintained long term, and if there are any effects on patient outcomes.
评估更新后的临床指南和文献对国家医疗服务体系中接受负荷超声心动图检查以评估诱发性心肌缺血患者管理的实际影响。
对2015年至2023年间英国32家医院转诊进行负荷超声心动图检查的13819例患者分两个阶段进行分析：第1阶段（2015 - 2020年）和第2阶段（2020 - 2023年）。通过英国国家医疗服务体系数字部门可获得4920名参与者的1年随访数据。第2阶段的患者更年轻，心血管风险状况更高，尽管各阶段的性别分布相似。负荷超声心动图检查结果呈阳性后的1年内，侵入性血管造影转诊病例数有所减少（P < 0.01），这似乎归因于中度心肌缺血（3 - 4节段）患者管理方式的改变（P < 0.01）。对于那些确实接受侵入性评估的患者，无论缺血负担如何，干预率均无变化（P = 0.27）。这种趋势在进行更多负荷超声心动图检查的中心最为明显。
英国的冠心病管理途径已发生变化，接受侵入性冠状动脉造影的中度心肌缺血患者减少。然而，冠状动脉干预率未变，这表明负荷超声心动图正用于改善侵入性检查的患者选择，同时尽量减少不必要的转诊。未来的工作将评估血管造影转诊减少是否能长期维持，以及对患者预后是否有任何影响。
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