American College of Cardiology

View all recommendations from this society

Released February 23, 2023

Avoid obtaining routine serial echocardiograms for chronic heart failure if there has been no change in signs, symptoms, or management.

Echocardiography is a readily available, accurate, noninvasive modality that is ideal for assessing pathology and monitoring treatment in patients with heart failure (HF). Once guideline-directed medical treatment has been optimized, echocardiography can be useful when making decisions regarding device therapy or referral to advanced therapies. For patients who are stable clinically and in whom no recent change in management has occurred or is contemplated, a routine schedule of serial echocardiograms is not useful.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American College of Cardiology (ACC) formed a Choosing Wisely workgroup of member leaders from the Board of Governors, subspecialty experts, and health policy specialists. The workgroup was tasked with identifying five clinical scenarios where specific tests, treatments, or procedures should be avoided for lack of benefit. These five recommendations were pulled from ACC’s existing appropriate use criteria (AUC) and clinical practice guidelines, selecting items that were either Rarely Appropriate AUC indications or Class III guideline recommendations. The ACC’s Clinical Policy Approval Committee and Science & Quality Committee then reviewed and approved the final five items.

ACC’s disclosure and conflict of interest policy can be found at


Maddox TM, Januzzi JL, Jr., Allen LA, et al. 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2021;77:772-810.

Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79:e263-e421.

Doherty JU, Kort S, Mehran R, et al. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2019 Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2019;73:488-516.