title: Association of survival time with transthoracic echocardiography in stable patients with heart failure: Is routine follow-up ever appropriate?
abstract: BACKGROUND
  The appropriateness of repeat transthoracic echocardiography (TTE) for stable heart failure (HF) is based on timing of the follow-up examination, but this lacks scientific support. We sought the association of routine follow-up TTE on survival and readmission in stable HF.
  
  
  METHODS
  Patients with HF were selected from consecutive HF admissions from 2008 to 2012. Groups were divided into: no follow-up TTE; routine <1year with no change in status ("rarely appropriate"), ≥1year follow-up with no change in status ("maybe appropriate") and TTE due to change in clinical status ("appropriate"). Survival analysis was performed for the combined endpoint of HF readmission and death, and a separate analysis was performed for HF readmission, with death as a competing risk.
  
  
  RESULTS
  Of 550 HF patients, 141 had a follow-up TTE, including 41 (29%) within 1year. The event-free time in years was similar between no TTE (1.10years [95%CI: 0.69, 1.49], routine TTE <1year (2.61years [95% CI: 1.08, 3.04], routine >1year (2.45years [95% CI: 1.37, 5.78]); all were greater than symptomatic patients (0.09years [95% CI: 0.02, 1.80]). HF readmission was independently associated with statins, renal disease, coronary angiography and NYHA class, but not follow-up TTE timing. There were no differences in the cumulative incidence for death between groups. There were no differences in change in management in routine TTE <1year and ≥1year.
  
  
  CONCLUSIONS
  The distinction of appropriateness of routine repeat TTE in stable HF patients, based on testing <1 or ≥1year after index admission appears unjustified.
authors.affiliation: Menzies Institute for Medical Research, Hobart, Australia.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Fonseca
authors.affiliation: Menzies Institute for Medical Research, Hobart, Australia.
authors.forename: Petr
authors.initials: P
authors.lastname: Otahal
authors.affiliation: Royal Hobart Hospital, Hobart, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Galligan
authors.affiliation: Royal Hobart Hospital, Hobart, Australia.
authors.forename: Samuel
authors.initials: S
authors.lastname: Neilson
authors.affiliation: Menzies Institute for Medical Research, Hobart, Australia.
authors.forename: Quan
authors.initials: Q
authors.lastname: Huynh
authors.affiliation: Menzies Institute for Medical Research, Hobart, Australia.
authors.forename: Makoto
authors.initials: M
authors.lastname: Saito
authors.affiliation: Menzies Institute for Medical Research, Hobart, Australia.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Negishi
authors.affiliation: Menzies Institute for Medical Research, Hobart, Australia; Baker-IDI Heart and Diabetes Institute, Melbourne, Australia. Electronic address: tom.marwick@bakeridi.edu.au.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Appropriate use; Echocardiography; Heart failure