Association of survival time with transthoracic echocardiography in stable patients with heart failure: Is routine follow-up ever appropriate?. (1st March 2017)

• Record Type: Journal Article
• Authors: Fonseca, Ricardo; Otahal, Petr; Galligan, John; Neilson, Samuel; Huynh, Quan; Saito, Makoto; Negishi, Kazuaki; Marwick, Thomas H
• Is Part Of: International journal of cardiology. Volume 230(2017)
• Page Start: 619
• Page End: 624
• Publication Date: 2017-03-01
• Subjects: Appropriate use -- Heart failure -- Echocardiography; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.12.043
• Languages: English
• ISSNs: 0167-5273

Abstract

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 < 1 year with no change in status ("rarely appropriate"), ≥ 1 year 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 1 year. The event-free time in years was similar between no TTE (1.10 years [95%CI: 0.69, 1.49], routine TTE < 1 year (2.61 years [95% CI: 1.08, 3.04], routine > 1 year (2.45 years [95% CI: 1.37, 5.78]); all were greater than symptomatic patients (0.09 years [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 < 1 year and ≥ 1 year. Conclusion: The distinction of appropriateness of routine repeat TTE in stable HF patients, based on testing < 1 or ≥ 1 year after index admission appears unjustified.