Policy Number: SRP 120
Policy Name: Exercise electrocardiogram (ECG) tolerance test
Status: Group Prior Approval
Effective Date: 1 November 2025
Next Review Date: 31 October 2028
An electrocardiographic clinical exercise tolerance test (ETT) is a non-invasive investigation, which may provide diagnostic and prognostic information about a range of cardiac conditions. The test involves continuous monitoring of a 12-lead electrocardiogram (ECG) while the patient performs cardiovascular exercise to a specific protocol, which may be on a treadmill or bicycle ergometer. Blood pressure is also measured regularly, and the patient’s symptoms are recorded.
Mid and South Essex ICB commissions ETT on a restricted basis in-line with guidance from the Professional Body for Cardiac Scientists (SCST).
Mid and South Essex ICB does not routinely commission ETT to screen for coronary heart disease (CHD) in asymptomatic and low risk patients aged 19 and over as it has a very low pre-test probability of identifying pathology. Risk calculators, such as Systematic Coronary Risk Evaluation (SCORE), are instead recommended to identify patients who are at greater risk of CHD.
Under the oversight of cardiologists, ETT has a limited diagnostic role and is reserved for:
- Patients with symptoms suggestive of CHD, where it aids in confirming or refuting diagnosis.
- Individuals with established CHD, to assess their functional capacity or gauge the severity of disease.
A summary of indications for performing ETT is shown in the table below.
| ETT for diagnosis? | ETT for ongoing management/prognosis/risk assessment? | |
|---|---|---|
| Coronary Artery Disease | No (Unless alternative testing unavailable) | Yes |
| Exercise-induced supraventricular arrhythmia | Yes (If symptoms clearly linked to exercise) | Yes (e.g. asymptomatic pre-excitation) |
| Valvular Heart Disease | No | Yes (Unmasking symptoms, risk assessment, timing of intervention) |
| Inherited cardiac conditions HCM LQTS CPVT AVC | No No Yes No | Yes Yes Yes Yes |
| Implantable cardiac rhythm management devices | No | Yes (chronotropic incompetence and rate response) |
| Chronotropic Incompetence | Yes | Yes |
ETT – exercise tolerance testing; HCM – hypertrophic cardiomyopathy; LQTS – long QT syndrome; CPVT – catecholaminergic polymorphic ventricular tachycardia; AVC – arrhythmogenic (ventricular) cardiomyopathy)
Not Funded
Exercise electrocardiograms (ECGs) for occupational fitness assessments—such as those required for driving or pilot licensing—are not funded by Mid and South Essex ICB. They may be accessed privately at the patient’s expense.
If performed within NHS services, they are only funded and coded under NHS tariff when there is clinical justification, not solely for occupational fitness purposes.
Patients not meeting the above criteria will not be funded unless there are clinically exceptional circumstances.
Individual funding requests should only be made where the patient demonstrates clinical exceptionality.
Further information on applying for funding in exceptional clinical circumstances can be found on the ICB website.
Reference:
- Exercise electrocardiogram (ECG) for screening for coronary heart disease
– Evidence-based Interventions Academy of Medical Royal Colleges - Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis
– NICE guideline [CG95] Last Updated November 2016 - Clinical Guidance by Consensus: Recommendations for Clinical Exercise Tolerance Testing
– SCST – The Professional Body for Cardiac Scientists. November 2023.