Changes in coronary disease management decisions in real-world practice between 2015 and 2023: insights from the EVAREST/BSE-NSTEP observational study
Authors' conclusion
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.
Study context
- Population
- Patients referred for stress echocardiography for the assessment of inducible ischaemia in UK hospitals between 2015 and 2023patients from 32 UK hospitals, 1-year follow-up data available for 4920 participants through NHS Digital
- Participants
- 13,819 patients
- Exposure
- Phase 1 and phase 2
- Outcome
- Patient characteristics
Methodological details32 UK hospitals, two phases
- 32 UK hospitals
- Two phases
Main finding
As reported in the abstract
- Patients in phase 2 were younger and presented with a higher cardiovascular risk profile, although sex distribution remained similar across phases
Observational data: associations, not effects.
Further findings
Invasive angiography referrals following a positive stress echocardiogram · within 1 year
- Observed reduction in invasive angiography referrals
- P < 0.01
- Attributed to changes in management of patients with moderate ischaemia (3-4 segments)
- P < 0.01
Intervention rate among those who received invasive assessment
- No changes in intervention rate, regardless of ischaemic burden
- P = 0.27
Trend by centre volume
- Trend most evident in centres performing a higher volume of stress echocardiograms
Original publication
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