Clinical Characteristics and Healthcare Resource Utilization among Patients with Obstructive Hypertrophic Cardiomyopathy Treated in a Range of Settings in the United States

Abstract

Obstructive hypertrophic cardiomyopathy (oHCM) has been studied primarily in comprehensive centers of excellence. Broadening the understanding of patients with oHCM in the general population may improve identification and treatment in other settings. This retrospective cohort study identified adults with oHCM from a large electronic medical record database comprising data from 39 integrated delivery networks (IBM Explorys; observational period: January 2009–July 2019). Clinical characteristics, healthcare resource utilization (HCRU), and outcomes were reported. Of 8791 patients, 53.0% were female and the mean index age was 61.8 years. Cardiovascular drugs prescribed included beta-blockers (80.5%), calcium channel blockers (46.0%), and disopyramide (2.4%). Over time, heart failure, atrial fibrillation, and ventricular arrhythmias increased. Surgical procedures included septal myectomy (22.0%), alcohol septal ablation (0.6%), and heart transplantation (0.3%). Implantable cardioverter defibrillators were present in 11.2% of patients. After initial septal reduction therapy (SRT), HCRU increased and 550 patients (27.7%) required a reintervention. Of the overall group, 2.7% experienced sudden cardiac arrest by end of study. In conclusion, this cohort of patients with oHCM had guideline-recommended drug therapy and procedures. Despite this, heart failure, atrial fibrillation, and ventricular arrhythmias increased, and more than a quarter of patients undergoing SRT required reintervention. These unresolved issues emphasize the unmet need for new, effective therapies for patients with oHCM.

Características Clínicas, Diagnósticas E De Tratamento Da Cardiomiopatia Hipertrófica Em Adultos: Uma Revisão De Literatura

“…Os padrões de herança mais comuns são herança autossômica dominante e mutações "de novo" em casos sem relação familiar (BISWAS; RAZA; DAS; KAPOOR et al, 2019;GUO;WANG;GU et al, 2020;HEDBERG-OLDFORS;ABRAMSSON;OSBORN;DANIELSSON et al, 2019;MARIAN;TAN;LI;CHANG et al, frêmito sistólico e impulso apical aumentado, além de pulso arterial "bisferiens" e onda "a" aumentada no pulso venoso (FARAHANI; ARUNACHALAM; SUNDARAM; PASUPATHY et al, 2020;ZHANG;GU et al, 2020). O uso de medicações somente está indicado a partir do início dos sintomas, sendo a primeira linha de tratamento os betabloqueadores (BUTZNER; ROWIN; YAKUBU; SEALE et al, 2022;MONDA;LIONCINO;PALMIERO;FRANCO et al, 2022;OWENS;SUTTON;GAO;FINE et al, 2022). Não há grandes estudos que comprovem diferença entre os fármacos dessa classe, mas algumas evidências sugerem que propranolol e fármacos antiarrítmicos de classe III como o sotalol podem ter maiores benefícios em pacientes com CMH (BUTZNER; ROWIN; YAKUBU; SEALE et al, 2022).…”

“…O uso de medicações somente está indicado a partir do início dos sintomas, sendo a primeira linha de tratamento os betabloqueadores (BUTZNER; ROWIN; YAKUBU; SEALE et al, 2022;MONDA;LIONCINO;PALMIERO;FRANCO et al, 2022;OWENS;SUTTON;GAO;FINE et al, 2022). Não há grandes estudos que comprovem diferença entre os fármacos dessa classe, mas algumas evidências sugerem que propranolol e fármacos antiarrítmicos de classe III como o sotalol podem ter maiores benefícios em pacientes com CMH (BUTZNER; ROWIN; YAKUBU; SEALE et al, 2022).…”

Resource utilization and costs related to the management of obstructive hypertrophic cardiomyopathy under the Brazilian supplementary healthcare system´s perspective: results from a modified Delphi panel

“…The questionnaires were emailed, and the specialists were given two weeks to respond. economic impact of the disease (Jain et al, 2021;Hurst et al, 2022;Owens et al, 2022;Butzner et al, 2022c;Yandrapalli et al, 2022;Javidgonbadi et al, 2021). Unfortunately, there is a lack of Brazilian data regarding this matter.…”

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“…The questionnaires were emailed, and the specialists were given two weeks to respond. economic impact of the disease (Jain et al, 2021;Hurst et al, 2022;Owens et al, 2022;Butzner et al, 2022c;Yandrapalli et al, 2022;Javidgonbadi et al, 2021). Unfortunately, there is a lack of Brazilian data regarding this matter.…”