Healthcare delivery is being transformed by COVID-19 to reduce transmission risk but continued delivery of routine clinical tests is essential . Stress echocardiography is one of the most widely used cardiac tests in the NHS . We assessed the impact of the first (W1) and second (W2) waves of the pandemic on ability to deliver stress echocardiography . Clinical echocardiography teams in 31 NHS hospitals participating in the EVAREST study were asked in July and November 2020 to complete a survey on the structure and delivery of stress echocardiography as well as impact on patients and staff . Results were compared to stress echocardiography activity in the same centre during January 2020 . 24 and 19 NHS hospitals completed the survey in July and November, respectively . A 55% reduction in the number of studies performed was reported in W1, recovering to exceed pre-COVID rates in W2 . The major change was in mode of stress delivery . 70% of sites stopped their exercise stress service in W1, compared to 19% in W2 . In those still using exercise during W1 , 50% were wearing FFP3/N95 masks, falling to 38% in W2 . There was also significant variability in patient screening practices with 7 different pre-screening questionnaires used in W1 and 6 in W2 . Stress echocardiography delivery restarted effectively after COVID-19 with adaptations to reduce transmission that means activity has been able to continue, and exceed, pre-COVID-19 levels during the second wave . Further standardisation of protocols for patient screening and PPE may help further improve consistency of practice within the UK.