Journal article
Long-term outcomes after stress echocardiography in real world practice: five-year follow-up of the UK Evarest study
- Abstract:
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Aims: Stress echocardiography is widely used to assess patients with chest pain. The clinical value of a positive or negative test result to inform on likely longer-term outcomes when applied in real-world practice across a healthcare system has not been previously reported.
Methods and results: Five thousand five hundred and three patients recruited across 32 UK NHS hospitals between 2018 and 2022, participating in the EVAREST/BSE-NSTEP prospective cohort study, with data on medical outcomes up to 2023 available from NHS England were included in the analysis. Stress echocardiography results were related to outcomes, including death, procedures, hospital admissions, and relevant cardiovascular diagnoses, based on Kaplan–Meier analysis and Cox proportional hazard ratios (HRs). Median follow-up was 829 days (interquartile range 224–1434). A positive stress echocardiogram was associated with a greater risk of myocardial infarction [HR 2.71, 95% confidence interval (CI) 1.73–4.24, P < 0.001] and a composite endpoint of cardiac-related mortality and myocardial infarction (HR 2.03, 95% CI 1.41–2.93, P < 0.001). Hazard ratios increased with ischaemic burden. A negative stress echocardiogram identified an event-free ‘warranty period’ of at least 5 years in patients with no prior history of coronary artery disease and 4 years for those with disease.
Conclusion: In real-world practice, the degree of myocardial ischaemia recorded by clinicians at stress echocardiography correctly categorizes risk of future events over the next 5 years. Reporting a stress echocardiogram as negative correctly identifies patients with no greater than a background risk of cardiovascular events over a similar time period.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 731.3KB, Terms of use)
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- Publisher copy:
- 10.1093/ehjci/jeae291
Authors
Contributors
- Role:
- Contributor
- Institution:
- University of Oxford
- Division:
- MSD
- Department:
- Nuffield Department of Population Health
- Role:
- Contributor
- Publisher:
- Oxford University Press
- Journal:
- European Heart Journal - Cardiovascular Imaging More from this journal
- Volume:
- 26
- Issue:
- 2
- Pages:
- 187-196
- Publication date:
- 2024-11-12
- Acceptance date:
- 2024-11-01
- DOI:
- EISSN:
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2047-2412
- ISSN:
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2047-2404
- Pmid:
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39531637
- Language:
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English
- Keywords:
- Pubs id:
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2063406
- Local pid:
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pubs:2063406
- Deposit date:
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2024-11-22
Terms of use
- Copyright holder:
- Woodward et al.
- Copyright date:
- 2024
- Rights statement:
- © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
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