Updated guidelines for hypertrophic cardiomyopathy (HCM) management emphasize shared decision-making between patients and their care teams.
“In the management of HCM, decisions around genetic testing, ICD [implantable cardioverter-defibrillator] implantation, invasive therapies for relief of LVOTO [left ventricular outflow tract obstruction], and participation in competitive or high-intensity exercise are particularly ripe for these crucial dialogues,” according to a writing group chaired by Steve Ommen, MD, of Mayo Clinic in Rochester, Minnesota.
“Some of these discussions and decisions could also represent opportunities where referral to centers with more comprehensive experience are most appropriate and highly impactful,” the authors added.
With the new guideline, published in the Journal of the American College of Cardiology and Circulation, the American College of Cardiology (ACC) and American Heart Association (AHA) revamped their 2011 recommendations for HCM.
The updates include a clarification of treatments recommended for obstructive versus non-obstructive HCM.
Ommen’s group also upgraded the recommendation that HCM patients undergo sudden cardiac death risk assessment every 1-2 years from class IIa to class I.
Additionally, the health benefits of physical activity were highlighted in a new class I recommendation for mild-to-moderate exercise in most HCM patients. A class I recommendation was given to sports participation among athletes after a discussion with their doctors.
Guideline authors pressed for more randomized controlled trials in the HCM space, acknowledging that many of their recommendations had been based on observational data or expert opinion.
Unmet needs include strategies to improve functional capacity, to attenuate disease progression, and to reduce adverse outcomes, according to Ommen and colleagues.
The ACC/AHA group also advocated greater access to genetic counseling and testing for all patients with HCM.
The guideline was developed in collaboration with and/or endorsed by the American Association for Thoracic Surgery, American Society of Echocardiography, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society for Cardiovascular Magnetic Resonance, and the Pediatric & Congenital Electrophysiology Society.
Last Updated November 20, 2020
Ommen had no disclosures.