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. 2019 Dec 5;6(2):e001186.
doi: 10.1136/openhrt-2019-001186. eCollection 2019.

UK perspective on the changing landscape of non-invasive cardiac testing

Alex Asher  1 , Rahul Ghelani  1 , George Thornton  1 , Krishnaraj Rathod  1 , Daniel Jones  1   2 , Andrew Wragg  2   1 , Adam Timmis  2   1
Affiliations

UK perspective on the changing landscape of non-invasive cardiac testing

Alex Asher et al. Open Heart. .

Abstract

Objective: To document UK rates of exercise treadmill testing, functional stress testing and CT coronary angiography (CTCA). Specific aims were to determine how rates have changed in the context of changing guideline recommendations within the UK and to identify regional inequalities in the utilisation of testing modalities. Secondary objectives were to compare these trends with national data on revascularisation.

Methods: 159 acute National Health Service trusts were served Freedom of Information (FOI) requests to provide total numbers of CTCA and functional imaging tests for each financial year from 2011-2012 to 2016-2017.

Results: The FOI requests yielded data from 88% of Trusts, increasing from 81.9% in 2011-2012% to 92.1% in 2016-2017. Exercise treadmill tests (ETTs) were performed by over 97% of Trusts. ETT was the most commonly performed diagnostic test in the UK across the study period despite declining by 8.4%. Utilisation of non-invasive stress imaging tests increased by 80.9% during the same period. Myocardial perfusion scintigraphy and stress echocardiography increased by 25.8% and 73.9%, respectively. The 268% increase in CTCA scans was yet greater. Trends in test utilisation during the study period showed important regional differences between devolved nations. Comparably, only small changes in rates of invasive coronary angiography and revascularisation have been reported during the study period.

Conclusion: Non-invasive imaging in UK Trusts has increased substantially since 2010 with only a small decline in use of the ETT and minimal changes in rates of invasive coronary angiography and revascularisation in the same time period.

Keywords: coronary artery disease; echocardiography; electrocardiography.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Methods flowchart. FOI, Freedom of Information; NHS, National Health Service.
Figure 2
Figure 2
Total number of cardiac tests performed in the UK. CMR, cardiac stress/perfusion MRI; CTCA, CT coronary angiography; ETT, exercise treadmill testing; MPS, myocardial perfusion scintigraphy; SE, stress echocardiography.
Figure 3
Figure 3
Cardiac Tests compared with Angiography and Revascularisation rate.
Figure 4
Figure 4
Heat maps demonstrating changes in regional variation in exercise treadmill testing and non-invasive imaging test utilisation in the UK.
Figure 5
Figure 5
Heat maps demonstrating changes in regional variation in non-invasive imaging test utilisation in the UK. CMR, cardiac stress/perfusion MRI; CTCA, CT coronary angiography; ETT, exercise treadmill testing; MPS, myocardial perfusion scintigraphy; SE, stress echocardiography.
See this image and copyright information in PMC

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