Why timely investigation matters

For patients presenting with symptoms or signs of possible cardiovascular disease, clinically significant risk may already be present while diagnostic evaluation is still pending.

The REVOLUTION HF study, a population-based observational study of 5,942 patients presenting to outpatient care with suspected de novo heart failure and elevated NT-proBNP, found that only 29% had received a heart failure diagnosis within one year. Among patients with a documented echocardiogram, the median time to imaging was 40 days. Rates of heart failure hospitalisation and mortality were highest in the early weeks following presentation, particularly among patients with markedly elevated NT-proBNP [1]. The authors highlighted the need for prompt identification, evaluation and appropriate treatment, and discussed earlier initiation of therapy in selected high-risk patients while confirmatory investigation is pending [1].

Barriers to timely specialist assessment are not confined to rural or remote settings. Australian data demonstrate socioeconomic inequality in specialist utilisation associated with out-of-pocket costs. Specialist visits involving out-of-pocket expenses disproportionately favoured people living in more advantaged areas, whereas visits without an out-of-pocket cost showed little socioeconomic inequality [2]. Consultant fees and bulk-billing rates also vary substantially between medical specialties and across Australian states and territories, resulting in considerable variation in the costs patients may face when accessing specialist care [3].

Stress echocardiography has established diagnostic and prognostic value. A 2025 systematic review and meta-analysis of 104 studies involving 16,824 symptomatic patients reported pooled sensitivity and specificity of 81% and 85%, respectively, for detecting obstructive coronary artery disease, compared with 66% and 61% for exercise stress ECG alone [4]. A separate meta-analysis found that a positive stress echocardiogram was associated with significantly higher long-term rates of major adverse cardiovascular events and all-cause mortality, supporting its role in cardiovascular risk stratification [5].

Zenith Cardiology's direct referral pathway is designed to reduce avoidable steps within the diagnostic pathway, allowing GPs to request clinically indicated cardiac investigations without requiring a specialist consultation as a prerequisite, where relevant clinical and Medicare requirements are met.