New US guideline for the management of hypertrophic cardiomyopathy

13/05/2024

The 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy (HCM) has been published in J Am Coll Cardiol.

This guideline updates the previous 2020 AHA/ACC guideline for the diagnosis and management of HCM, making new recommendations for medical practice in the US based on new evidence.

Brief overview of the top 10 take-home messages

  1. In order to provide the best clinical care, shared decision-making between patients, families and their care team is important.
  2. Referral to a multidisciplinary HCM center with appropriate expertise is important for optimizing patient care.
  3. Genetic and family screening, as well as counseling patients about the potential for genetic transmission of HCM, are essential in the management of patients with HCM.
  4. Highlights the importance of assessing the risk of sudden cardiac death in patients with HCM. Estimating the individual risk score will be helpful to facilitate the patient’s ability to participate in decision-making regarding ICD placement.
  5. Assessing the risk of sudden cardiac death in patients with HCM differs between children and adults.
  6. Cardiac myosin inhibitors are available to treat patients with symptomatic obstructive HCM. At the moment, only mavacamten has been approved for the treatment of HCM in the US. Cardiac myosin inhibitors can be beneficial in patients with obstructive HCM who do not derive adequate benefit from first-line drug therapy.
  7. Invasive septal reduction therapy can provide safe and effective relief for HCM patients with drug-refractory or severe outflow tract obstruction. Data indicate that there are improved outcomes at comprehensive HCM centers, thereby representing an ideal opportunity for referral to expertise centers.
  8. Patients with HCM and AF have an increased risk of stroke therefore oral anticoagulation with DOACs should be considered the default treatment option irrespective of the CHA2DS2-VASc score. Maintenace of sinus rhythm and rate control are also important in patients with HCM as rapid AF is often poorly tolerated in patients with HCM.
  9. Exercise stress testing in patients with HCM is helpful to determine overall exercise tolerance and to provoke latent ventricular outflow tract obstruction.
  10. Increasing amount of data indicate that exercise is beneficial in patients with HCM. Short-term studies have indicated that there is no association between healthy recreational exercise and increased risk of ventricular arrhythmia events. Comprehensive discussion and input from expert HCM professionals is essential when patients want to engage in rigorous exercise training for performance or competition.

Find the publication of the guideline online at J Am Coll Cardiol.

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