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  1. Robert J MacFadyen,
  2. Thomas M Macdonald,
  3. Peter Clarkson,
  4. Nigel M Wheeldon
  1. Lecturer Senior lecturer Research fellow Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee DD1 9SY
  2. Senior registrar Department of Cardiology, Northern General Hospital, Sheffield S5 7AU

    EDITOR,--Both the paper by C M Francis and colleagues1 and the accompanying editorial2 regarding open access echocardiography for heart failure might be interpreted as suggesting that a key role of such a service is the withdrawal of “inappropriate” drug treatment. It is suggested that this decision should be based on one echocardiographic examination per subject, with what might be regarded as a higher than average rate of non-quantitative study (42% quoted). If it is assumed, as is implied, that there was no corroborative history nor examination performed to assess patients further, …

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