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Real-World Evaluation of Guideline-Directed Treatments in Patients With Obstructive Hypertrophic Cardiomyopathy in

Farbod Sedaghat-Hamedani1,2, Carla Zema3, Michael Schultze4

  • 1Institute for Cardiomyopathies and Center for Cardiogenetics, Department of Medicine III, University of Heidelberg, Heidelberg, Germany.

Clinical Medicine Insights. Cardiology
|July 1, 2026
PubMed

Insights

Real-world treatment for obstructive hypertrophic cardiomyopathy (HCM) in Germany shows significant gaps in guideline adherence. Many patients do not receive recommended pharmacological therapies, highlighting a need for improved clinical education.

Area of Science:

  • Cardiology
  • Pharmacology
  • Health Services Research

Background:

  • Obstructive hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy and outflow tract obstruction.
  • European Society of Cardiology (ESC) guidelines provide clear recommendations for medical therapy.
  • Real-world adherence to these guidelines for obstructive HCM in Germany is not well-established.

Purpose of the Study:

  • To evaluate adherence to ESC guidelines for obstructive HCM management in Germany.
  • To identify gaps in pharmacological and invasive therapies for obstructive HCM.
  • To assess the alignment of real-world treatment with established clinical guidelines.

Main Methods:

  • Retrospective cohort analysis of administrative claims data (WIG2 Benchmark database) from 2012-2018.
  • Inclusion of patients aged ≥18 years with an ICD-coded diagnosis of HCM.
  • Assessment of treatment alignment against current ESC guidelines for HCM.

Main Results:

  • Out of 1141 patients with obstructive HCM, only 57% received treatments consistent with ESC guidelines.
  • 18% received beta-blocker (BB) monotherapy and 12% received calcium channel blocker (CCB) monotherapy as recommended.
  • 43% of treatment combinations were non-compliant, including use of contraindicated medications; 22% received no pharmacological treatment.

Conclusions:

  • Significant deviations from ESC guidelines in obstructive HCM management were observed in Germany.
  • There is a critical need for enhanced clinician education on guideline-directed medical therapy for obstructive HCM.
  • Improving adherence to guidelines is essential for enhancing patient well-being and outcomes.
Abstract

Keywords:
European Society of Cardiology (ESC) guidelinesleft ventricular outflow tract obstructionobstructive hypertrophic cardiomyopathypharmacological treatmentunmet need

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