Survival After Septal Reduction in Patients >65 Years Old With Obstructive Hypertrophic Cardiomyopathy

Area of Science:

• Cardiology
• Interventional Cardiology
• Geriatric Medicine

Background:

• Obstructive hypertrophic cardiomyopathy (oHCM) is increasingly diagnosed in elderly populations.
• Septal reduction therapies (SRT) are treatment options for symptomatic oHCM.

Purpose of the Study:

• To evaluate long-term outcomes of septal reduction therapies (SRT) in Medicare patients with oHCM.
• To investigate the relationship between hospital volume and outcomes for SRT in oHCM patients.

Main Methods:

• Retrospective analysis of Medicare beneficiaries aged >65 years who underwent septal myectomy (SM) or alcohol septal ablation (ASA) between 2013-2019.
• Used overlap propensity score weighting to adjust for baseline differences between SM and ASA groups.
• Assessed all-cause mortality, heart failure (HF) readmission, and need for redo SRT as primary and secondary outcomes.

Main Results:

• Septal myectomy (SM) was associated with lower rates of redo SRT and improved survival after 2 years compared to alcohol septal ablation (ASA).
• Both SM and ASA reduced heart failure readmissions in the follow-up period compared to the year prior to SRT.
• Higher-volume centers demonstrated better outcomes, yet 70% of SRT procedures were performed in low-volume centers.

Conclusions:

• Septal reduction therapies (SRT) effectively reduce heart failure readmissions in elderly Medicare patients with obstructive hypertrophic cardiomyopathy (oHCM).
• Septal myectomy (SM) offers superior long-term survival and reduced need for repeat procedures compared to alcohol septal ablation (ASA).
• There is a critical disparity in care delivery, with high-volume centers showing better outcomes while most procedures occur in low-volume settings.