Over the last few years there has been a revolution in open access echocardiography services due to an increased demand from within secondary care and primary care. There have been some concerns expressed by specialists and open access echocardiography has not been universally welcomed as a means of offering healthcare. Suspected heart failure comprises the majority of primary care referrals for open access echocardiography. There is lack of rigorously controlled studies to support widespread establishment of open access echocardiography services.