Managing Hypertrophic Cardiomyopathy
Treatment options are available for the management of HCM
For patients with non-obstructive HCM, guideline-recommended treatment is typically guided by LVEF. For patients with preserved ejection fraction, beta blockers and calcium channel blockers are recommended as Class 1 first-line options.1
In patients with LVEF <50%, recommendations include diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers (with or without neprilysin inhibitor), beta blockers, mineralocorticoid receptor agonists, and SGLT2 inhibitors.1,2
Evolving Research May Offer Renewed Hope for Patients1
Medications like beta blockers and calcium channel blockers are used as guideline-based 1L treatments for obstructive HCM. While effective at improving symptoms, the benefit these drugs have on obstructive HCM is based on limited evidence from randomized controlled trials.1
Patients with obstructive HCM can also benefit from cardiac myosin inhibitors, disopyramide, and SRT procedures when symptoms persist on 1L treatments.1*
Every Patient Deserves the Possibility of Symptom Relief
With a progressive disease like HCM, a patient’s condition may worsen over time, resulting in more severe symptoms. It’s important to discuss the full burden of symptoms with your patients and engage in shared decision-making to determine the most appropriate and effective treatment for them.1
The treatment landscape for oHCM continues to evolve. Developing a safe and effective therapy that can impact disease progression remains a major therapeutic goal.1,3
*Symptoms include effort-related dyspnea or chest pain and occasionally other exertional symptoms (eg, syncope, near syncope) that are attributed to LVOT obstruction and interfere with everyday activity or quality of life despite beta blocker or nondihydropyridine calcium channel blocker.1
1L=first line; SRT=septal reduction therapy.
Please refer to the 2024 AHA/ACC/Multisociety HCM Guideline for recommendations and management algorithms
Monitoring HCM Disease Progression Over Time
Dr. Owens and
Dr. Silvestri discuss challenges in evaluating changes in disease over time and their approach with their patients
Patients may be on a path to unmanaged symptoms4-6
Given that disease progression is generally slow in HCM, patients experiencing symptoms may adapt to their disease and accept limitations without thinking to inform their healthcare provider.4,5 This can lead to unmanaged symptoms and lifestyle changes that negatively affect their emotional state and social functioning.6
Discussing HCM symptoms and monitoring the impact HCM has on patient’s physical, emotional, and psychological functioning is an important part of clinical assessments of disease severity and progression. Given the multiple aspects of lifestyle HCM can impact, an open conversation with patients, continued over multiple visits, can be helpful in establishing appropriate management.3,5
Guideline Recommendations for Monitoring HCM Patients1
Continuous evaluation is essential to support care for patients with HCM1
Test1 |
Guideline Recommended Frequency1 |
| 12–Lead ECG or TTE | Every 1–2 years |
| 24– to 48–hour ambulatory ECG monitoring | Every 1–2 years |
| Cardiopulmonary exercise testing | Every 2–3 years for patients whose functional capacity or symptom status is uncertain |
| CMR imaging | Every 3–5 years |
Engaging patients in conversations about their disease—and how it may evolve over time—is essential in delivering high-quality care1
REFERENCES:
- Ommen SR, Ho CY, Asif IM, et al. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the management of hypertrophic cardiomyopathy: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(23):e1239-e1311.
- Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032.
- Maron BJ, Rowin EJ, Maron MS. Advances in the management of hypertrophic cardiomyopathy leading to low disease-related mortality in 2023. Am J Cardiol. 2024;212:S77-S82.
- Jacoby DL, DePasquale EC, McKenna WJ. Hypertrophic cardiomyopathy: diagnosis, risk stratification and treatment. CMAJ. 2013;185(2):127-134.
- Naidu SS, ed. Hypertrophic Cardiomyopathy. London, Eng: Springer-Verlag; 2015.
- Sweeting J, Ingles J, Timperio A, Patterson J, Ball K, Semsarian C. Physical activity in hypertrophic cardiomyopathy: prevalence of inactivity and perceived barriers. Open Heart. 2016;3(2):e000484.