Although there are scant data on which to base a definitive recommendation, the writing committee recommends a clin- ical follow-up evaluation every 4 to 12 months. A more precise interval cannot be recommended because many fac- tors influence the length of the follow-up period, including sharing of care by family physicians, internists, and cardiol- ogists, which will vary with regional practice patterns, patient preference, and physician availability. During the first year of therapy, evaluations every 4 to 6 months are recommended. After the first year of therapy, evaluations every 6 to 12 months are recommended if the patient is stable and reliable enough to call or make an appointment when symptoms or functional capacity become worse. Limited data from obser- vational studies indicate that outcomes might be better for patients who receive follow-up from a cardiologist.1229,1230 When patients are managed jointly by their primary care physician and cardiologist, effective communication between physicians is essential. This ultimately will be facilitated by effective implementation of accessible electronic medical records. Periodic office visits can be supplemented by tele- phone, e-mail, or other types of contact between the patient and the healthcare team. 6.2.2. Focused Follow-Up Visit: Interval History and Coexisting Conditions Although follow-up of patients with SIHD often is focused on periodic testing, the most crucial element is a careful interval history. Key elements of the history are: Changes in physical activity or symptoms; Response to therapy, adverse effects, and adherence to recommendations; and Development of relevant, new chronic conditions or changes in existing conditions. Symptomatic change and decreasing functional capacity are important markers for increased risk in patients with SIHD, particularly with increasing age and additional comor- bidities. The evaluation of symptoms should be detailed and directed, as many patients are reluctant to volunteer such information. 