Association of survival time with transthoracic echocardiography in stable patients with heart failure: Is routine follow-up ever appropriate?

• Published in: International journal of cardiology 2017-03, Vol.230, p.619-624
• Main Authors: Fonseca, Ricardo, Otahal, Petr, Galligan, John, Neilson, Samuel, Huynh, Quan, Saito, Makoto, Negishi, Kazuaki, Marwick, Thomas H
• Format: Article
• Language: English
• Subjects: Aged; Appropriate use; Australia - epidemiology; Cardiovascular; Echocardiography; Echocardiography - methods; Female; Follow-Up Studies; Heart failure; Heart Failure - diagnosis; Heart Failure - mortality; Humans; Male; Middle Aged; Patient Readmission - trends; Retrospective Studies; Risk Assessment - methods; Survival Rate - trends; Time Factors
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2016.12.043

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.