Objectives: We evaluated the use and the impact of echocardiography in patients receiving an initial diagnosis of congestive heart failure.

Background: An echocardiogram is recommended in all patients with suspected congestive heart failure. Few data are available on use and impact of echocardiography in management of congestive heart failure.

Methods: We prospectively included 799 concecutive patients (pts) admitted for a first CHF episode during the year 2000. 648 (81%) underwent echocardiography during their hospitalization (Echo group), and the other 151 pts constitute the No-Echo group. Baseline chararacteristics and 5 year survival of the Echo group and of the No-Echo group were compared.

Results: The No-Echo group pts were older and were more likely to be female. They have more coronary artery disease. The No-Echo group pts received at discharge less ACE inhibitors, less beta-blockers and less spironolactone. Advanced age (RR = 1.08; CI [1.06-1.1]; p < 0.001), absence of cardiomegaly (RR = 2.04; CI [1.4-3.1]; p < 0.001) and hospitalization in a general medicine department (RR = 2.7; CI = [1.88-4.1]; p < 0.001) were independently related to the decision not to perform an echocardiogram. The 1 year (48% versus 76%; p < 0.001), 3 year (32% versus 57%; p < 0.001) and 5 year (21% versus 44%; p < 0.001) survivals were lower in the No-Echo group. However, after adjustment for age, there was no significant difference (p = 0.1).

Conclusion: The underuse of echocardiography after a first episode of CHF appears to be associated with advanced age and with the underuse of ACE inhibitors, beta-blockers and spironolactone.