Evidence map›Paper›PMID 40119705›Full record

Observational studyEuropean heart journal. Cardiovascular Imaging2025

Changes in coronary disease management decisions in real-world practice between 2015 and 2023: insights from the EVAREST/BSE-NSTEP observational study.

Casey L Johnson, Samuel Krasner, William Woodward, Emma Mao, Annabelle McCourt, Cameron Dockerill, Katrin Balkhausen, Badrinathan Chandrasekaran, Attila Kardos, Nikant Sabharwal and 14 more

Abstract readObservational StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in European heart journal. Cardiovascular Imaging, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

24 authors.

Casey L JohnsonCardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.ORCID 0000-0001-6281-3523
Samuel KrasnerCardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.ORCID 0000-0003-3671-6978
William WoodwardCardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.ORCID 0000-0001-9875-4983
Emma MaoCardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.
Annabelle McCourtCardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.
Cameron DockerillCardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.
Katrin BalkhausenRoyal Berkshire Hospital, Reading, UK.
Badrinathan ChandrasekaranGreat Western Hospital, Swindon, UK.ORCID 0000-0002-2265-0501
Attila KardosDepartment of Cardiology, Translational Cardiovascular Research Group, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK.ORCID 0000-0002-0231-7605
Nikant SabharwalOxford University Hospitals NHS Foundation Trust, Oxford, UK.ORCID 0000-0002-1989-947X
Soroosh FiroozanWycombe Hospital, High Wycombe, UK.
Rizwan SarwarOxford University Hospitals NHS Foundation Trust, Oxford, UK.
Roxy SeniorNorthwick Park Hospital, London, UK.ORCID 0000-0001-6579-7039
Rajan SharmaSt George's University Hospitals NHS Foundation Trust, Tooting, UK.
Kenneth WongLancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
Daniel X AugustineRoyal United Hospitals, Bath, UK.
Maria PatonLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Jamie O'DriscollSt George's University Hospitals NHS Foundation Trust, Tooting, UK.
David OxboroughResearch Institute for Sport and Exercise Sciences and the Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK.ORCID 0000-0002-1334-3286
Keith PearceMachester University NHS Foundation Trust, Manchester, UK.
Shaun RobinsonImperial Healthcare NHS Trust, London, UK.
James WillisRoyal United Hospitals, Bath, UK.
Paul LeesonCardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.ORCID 0000-0001-9181-9297
EVAREST/BSE-NSTEP Investigators

Funding

Cardiovascular Clinical Research FacilityLantheus Medical Imaging IncNational Institute for Health Research Health Education England Healthcare Science Research Fellowship NIHR-HCS-P13-04-001National Institute for Health Research Oxford Biomedical Research CentreUltromics Ltd.University of Oxford
6 · The paper itself

Abstract

aimsTo 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. METHODS AND

resultsA 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.

conclusionCoronary 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.

Indexed as

Coronary Artery DiseaseEchocardiography, StressAgedClinical Decision-MakingCoronary AngiographyDisease ManagementFemaleHumansMaleMiddle AgedPractice Guidelines as TopicRisk AssessmentUnited Kingdomcoronary artery diseaseechocardiographyinvasive coronary angiographystress echocardiography

Identifiers

PMID40119705
PMCPMC12206575

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.