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Hypertrophic Cardiomyopathy in "Real-World" Community Cardiology Practice

Ethan J Rowin1, Martin S Maron1, Viraj Bhatt2

  • 1Hypertrophic Cardiomyopathy Institute, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts; Chanin T. Mast Hypertrophic Cardiomyopathy Center, Morristown Medical Center, Morristown, New Jersey.

The American Journal of Cardiology
|March 11, 2020
PubMed

Insights

Hypertrophic cardiomyopathy (HC) patients in community cardiology practice show similar disease presentation and outcomes to those in referral centers. However, timely intervention for outflow obstruction and accurate sudden death risk assessment require attention in community settings.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Hypertrophic cardiomyopathy (HC) management and outcomes can vary between community cardiology practices and specialized referral centers.
  • Understanding these differences is crucial for optimizing patient care and ensuring consistent treatment strategies.

Purpose of the Study:

  • To compare the clinical presentation, natural history, and management of hypertrophic cardiomyopathy (HC) patients in a community cardiology setting versus a referral center cohort.
  • To identify potential disparities in disease expression, symptom progression, and treatment approaches.

Main Methods:

  • A cross-sectional analysis of 253 consecutive HC patients managed in a "real-world" clinical cardiology practice.
  • Comparison of patient characteristics, left ventricular (LV) wall thickness, outflow obstruction, symptoms, atrial fibrillation, sudden death (SD) events, and interventions with a highly selected referral center cohort.

Main Results:

  • HC patients in community practice demonstrated similar disease expression and natural history to referral patients, with stable and largely benign clinical courses.
  • Progressive heart failure symptoms were more common in the referral cohort (36% vs. 26%).
  • Implantable cardioverter-defibrillators (ICDs) were used for SD prevention in community practice, though risk was overestimated in some cases. Delays in recommending surgical myectomy or septal ablation for drug-refractory outflow obstruction were noted.

Conclusions:

  • Clinical characteristics and the course of HC patients in community practice generally mirror those in HC referral centers.
  • Community cardiologists largely adhere to guideline-based strategies, but opportunities exist to improve SD risk assessment and the timely management of outflow obstruction.
  • Optimizing intervention strategies for severe symptoms and outflow obstruction is essential for improving outcomes in community-based HC management.

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