AHA/ACC: New Guidelines on Hypertrophic Cardiomyopathy Management

The American Heart Association and the American College of Cardiology have released new clinical practice guidelines on the management of hypertrophic cardiomyopathy (HCM).

“Many recommendations from the earlier hypertrophic cardiomyopathy guidelines have been updated with new evidence or a better understanding of earlier evidence,” the committee wrote.

This update follows a comprehensive literature review of relevant evidence from several databases, including PubMed, EMBASE, the Cochrane Collaboration, and Agency for Healthcare Research and Quality reports, among others. The literature review began in January 2010 and ended in April 2020.

Recommendations in this executive summary include:

• Emphasis on shared decision-making between patients and physicians, including patient’s treatment goals
• Referral to multidisciplinary HCM centers for optimal care for patients with HCM
• Counseling patients with HCM for the genetic transmission of HCM is important, and screening first-degree family members can begin at any age
• Cardiovascular magnetic resonance imaging is a useful tool when there is diagnostic uncertainty or uncertainty for placement of an implantable cardioverter-defibrillator (ICD). However, the standard imaging tool is still echocardiography
• Assessment of risk for sudden cardiac death (SCD) in patients adjusts as new markers emerge, such as apical aneurysm, decreased left ventricular systolic function, and extensive gadolinium enhancement
• Children with HCM have different risk factors for SCD and thresholds for ICD implantation than adults with HCM

“This summary operationalizes the recommendations from the full guideline and presents a combination of diagnostic work-up, genetic and family screening, risk stratification approaches, lifestyle modifications, surgical and catheter interventions, and medications that constitute components of guideline directed medical therapy,” the researchers concluded. “For both guideline-directed medical therapy and other recommended drug treatment regimens, the reader is advised to follow dosing, contraindications and drug-drug interactions based on product insert materials.”

—Leigh Precopio

Reference:

Writing Committee Members, Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. J Am Coll Cardiol. Published online November 20, 2020. doi:10.1016/j.jacc.2020.08.044