Contemporary review of stress echocardiography workforce within the UK: an EVAREST/BSE NSTEP study

Willis, J, Johnson, CL, Krasner, S ORCID: 0000-0003-3671-6978, Woodward, W, McCourt, A, Dockerill, C, Balkhausen, K, Chandrasekaran, B, Kardos, A, Sabharwal, N, Firoozan, S, Sarwar, R, Senior, R, Sharma, R, Wong, K, Paton, M, O'Driscoll, J, Oxborough, D ORCID: 0000-0002-1334-3286, Pearce, K, Robinson, S et al (2025) Contemporary review of stress echocardiography workforce within the UK: an EVAREST/BSE NSTEP study. Echo research and practice, 12 (1). p. 22. ISSN 2055-0464

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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.

Item Type:	Article
Uncontrolled Keywords:	EVAREST/BSE-NSTEP Investigators; Ischaemic heart disease; Stress echocardiography; Workforce; 4203 Health Services and Systems; 32 Biomedical and Clinical Sciences; 42 Health Sciences; Cardiovascular; Heart Disease; 8.1 Organisation and delivery of services
Subjects:	Q Science > QP Physiology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions:	Sport and Exercise Sciences
Publisher:	BMC Springer Nature
Date of acceptance:	7 July 2025
Date of first compliant Open Access:	6 November 2025
Date Deposited:	06 Nov 2025 13:08
Last Modified:	06 Nov 2025 13:15
DOI or ID number:	10.1186/s44156-025-00088-x
URI:	https://researchonline.ljmu.ac.uk/id/eprint/27506

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