Golbus JR, et al. - This study was undertaken to investigate which clinical characteristics prognosticate continuation of routine surveillance studies, outcomes following discontinuation of routine surveillance, and the cost‐effectiveness of different surveillance strategies in patients greater than 2 years post‐heart transplant (HT). Researchers retrospectively distinguished individuals older than 18 who had undergone a first HT at our centre and who survived ≥ 760 days (n  = 217) post‐HT. They reviewed clinical context surrounding all endomyocardial biopsies and gene expression profiles to ascertain whether studies were conducted routinely or were triggered by a change in clinical status. Individuals were classified as following a test‐based surveillance (n  = 159) or a signs/symptoms surveillance (n  = 53) strategy based on treating cardiologist intent to continue routine studies after the second post‐transplant year. They constructed a Markov model to compare two test‐based surveillance strategies to a baseline strategy of discontinuing routine studies. The data reveal that acute asymptomatic rejection is rare after the second post‐transplant year. It was shown that obtaining surveillance studies beyond the second post‐transplant year is not cost‐effective.