Abstract
Background: Stress echocardiography is a key imaging modality for assessing coronary artery disease in the UK. Traditionally, stress echo services were led by consultant cardiologists, but evolving workforce models have increased the involvement of cardiac physiologists and scientists. This study, as part of the National Review of Stress Echocardiography Practice (BSE N-STEP), aimed to evaluate current stress echo workforce structures and test outcomes across a group of UK hospitals to inform future workforce planning. Results: Data were analysed from 8506 stress echocardiograms, conducted between September 2020 and June 2023 across 34 UK hospitals. Based on the supervising workforce, stress echocardiograms were allocated into either a doctor-led (DL) or cardiac physiologist/scientist and nurse-led (CNL) model. 56.9% of stress echocardiograms were DL, while 42.7% were conducted under a CNL model. Physiologists/scientists were the most frequently involved staff (81.9%). The primary indication for stress echocardiography was ischaemia evaluation (89.4%). Dobutamine stress echocardiography was more common in DL services (63.0 vs. 56.3%, p < 0.001), while CNL services performed more exercise stress echocardiography (42.8 vs. 36.4%, p < 0.001). Test positivity rates were similar between DL and CNL models (17.1 vs. 17.7%, p = ns), though the CNL group had a lower complication rate (2.2 vs. 5.3%, p < 0.001). Reporting of stress echocardiograms remained consultant-led in 82% of cases, but physiologist/scientist-led reporting showed an increase over time. Training was primarily provided to registrars/fellows (60.2%), with physiologist/scientist trainees accounting for 32.4%. Conclusions: This study provides a contemporary overview of stress echocardiography workforce models in the UK, highlighting the increasing role of cardiac physiologists and scientists in supervising and reporting stress echocardiography. Despite these shifts, consultant cardiologists remain central to stress echo reporting. The findings support the integration of multidisciplinary workforce models to enhance service efficiency. These insights will aid in future workforce planning and training strategies to optimise stress echocardiography service provision across the NHS.
| Original language | English |
|---|---|
| Article number | 22 |
| Number of pages | 9 |
| Journal | Echo Research and Practice |
| Volume | 12 |
| Issue number | 1 |
| Early online date | 10 Oct 2025 |
| DOIs | |
| Publication status | Published - 10 Oct 2025 |
Data Availability Statement
The data underlying this article will be shared on reasonable request to the corresponding author.Acknowledgements
Abraheem Abraheem21,Sanjay Banypersad22,
Sadie Bennett23,
Henry
Boardman8,
Christopher Boos24,
Sudantha Bulugahapitiya25,
Jeremy
Butts26,
Duncan Coles27
Joanna d’Arcy8, Jacob Easaw 1, Sarah Fairbairn28,
Patrick Gibson29,
Haytham Hamdan30,
Shahnaz Jamil-Copley31 Gajen
Kanaganayagam32,
Guy Lloyd33,
Ioannis Moukas34,
Tom Mwambingu35,
Thuraia Nageh36,
Antonis Pantazis37,
Alexandros Papachristidis38,
Ronak
Rajani39,
Muhammad Amer Rasheed40,
Naveed A. Razvi41,
Sushma Rekhraj30,
Joban Sehmi42,
Azeem Sheikh24
David P. Ripley43,
Kathleen Rose44,
Michaela Scheuermann-Freestone45, Rebecca Schofield46,
Ayyaz Sultan30,
Nancy
Spagou47,
Ross Upton47,
Gary Woodward47,
Spiros Zidros48.
21Department
of Cardiology, Tameside and Glossop Integrated Care NHS Foundation Trust,
Ashton-under-Lyne, UK. 22Department of Cardiology, East Lancashire Hospitals
NHS Trust, Burnley, UK. 23Department of Cardiology, Heart & Lung Centre,
Royal Stoke University Hospital, University Hospitals of North Midlands NHS
Foundation Trust, Stoke, UK. 24Department of Cardiology, Poole Hospital NHS
Foundation Trust, Poole, UK. 25 Department of Cardiology, Bradford Teaching
Hospitals NHS Foundation Trust, Bradford, UK. 26 Department of Cardiology,
Calderdale and Huddersfield NHS Foundation Trust, Calderdale, UK. 27Department
of Cardiology, Broomfield Hospital, Mid and South Essex NHS Foundation
Trust, Broomfield, UK. 28Bristol Heart Institute, University Hospitals Bristol
and Weston NHS Foundation Trust, Bristol, UK. 29Royal Infirmary Edinburgh
and Western General Hospital, NHS Lothian, UK. 30Department of Cardiology,
Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK. 31Department
of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham,
UK. 32Department of Cardiology, Chelsea and Westminster Hospital NHS
Foundation Trust, London, UK. 33 University College London, Barts Health
NHS Trust, UK. 34Department of Cardiology, Warrington and Halton Teaching
Hospitals NHS Foundation Trust, Warrington, UK. 35Department of Cardiology,
The Mid Yorkshire Hospitals NHS Trust, Pinderfields, UK. 36Department of Cardiology,
Southend University Hospital, Mid and South Essex NHS Foundation
Trust, Southend-on-Sea, UK. 37Department of Cardiology, North Middlesex
University Hospital NHS Trust, London, UK. 38Department of Cardiology, King’s
College Hospital NHS Foundation Trust, London, UK. 39Department of Cardiology,
Guy’s and St Thomas’ NHS Foundation Trust, London, UK., 40Department
of Cardiology, Yeovil District Hospital, Somerset NHS Foundation Trust, Yeovil,
UK. 41Department of Cardiology, East Suffolk and North Essex NHS Foundation
Trust, Ipswich, UK. 42 West Hertfordshire Hospitals NHS Trust, UK. 43Department
of Cardiology, Northumbria Healthcare NHS Foundation Trust, North Tyneside,
UK. 44Department of Cardiology, Northampton General Hospital NHS Trust,
Northampton, UK. 45Department of Cardiology, Hampshire Hospitals NHS
Foundation Trust, Basingstoke, UK. 46Department of Cardiology, North West
Anglia NHS Foundation Trust, Peterborough, UK. 47Ultromics Ltd, Oxford, UK.
48Department of Cardiology, Bedford Hospital, Bedfordshire Hospitals NHS
Foundation Trust, Bedford, UK.
Funding
This work was supported by National Institute for Health Research Health Education England Healthcare Science Research Fellowship [NIHR-HCSP13- 04–001]; Cardiovascular Clinical Research Facility, University of Oxford; Ultromics Ltd.; Lantheus Medical Imaging Inc. and National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford. The funders of the study had no role in study design, data collection, analysis, interpretation, or writing of the report.
Keywords
- Ischaemic heart disease
- Stress echocardiography
- Workforce
ASJC Scopus subject areas
- Radiological and Ultrasound Technology
- Radiology Nuclear Medicine and imaging
- Advanced and Specialised Nursing