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Management Strategy in 249 Consecutive Patients With Obstructive Hypertrophic Cardiomyopathy Referred to a Dedicated Program
- Source :
- The American Journal of Cardiology. 110:1169-1174
- Publication Year :
- 2012
- Publisher :
- Elsevier BV, 2012.
-
Abstract
- The likelihood of success of conservative management of obstructive hypertrophic cardiomyopathy (HC) and the predictors of failure of conservative therapy are not known. We therefore evaluated the efficacy of an algorithm for the management of symptoms and predictors of failed conservative therapy in 249 consecutive symptomatic patients with obstructive HC referred to a dedicated HC program for management in general or for septal reduction therapy (SRT) in particular. There was considerable practice variation in the extent to which conservative therapy was optimized before referral for SRT. Over 3.7 ± 2.9-year follow-up, symptoms resolved with addition of or increase in dosage of a β blocker, calcium channel blocker, or disopyramide in 16%, 10%, and 10% of patients, respectively. Pacing with short atrioventricular delay controlled symptoms in 4 of 9 patients. In 63% of patients, conservative measures failed to control symptoms. Multivariate predictors of failure of conservative therapy were presence of New York Heart Association class III or IV symptoms (hazard ratio 2.0, 95% confidence interval 1.4 to 2.9, p = 0.001) and greater septal wall thickness (hazard ratio 1.06, 95% confidence interval 1.02 to 1.10, p = 0.003) at presentation. At time of presentation, 93 patients (37%) were already on optimal therapy and were referred for SRT. Of the remaining 156 patients who did not require immediate SRT, 93 (60%) were free from a recommendation for SRT at the end of the follow-up period. In conclusion, in symptomatic patients with obstructive HC, conservative therapy is successful in >1/3 of referred patients at 3.7-year follow-up, obviating SRT in these patients. Clinicians in programs offering SRT should optimize conservative therapy before recommending SRT.
- Subjects :
- Male
medicine.medical_specialty
medicine.drug_class
Adrenergic beta-Antagonists
Cardiomyopathy
Calcium channel blocker
Text mining
Risk Factors
Internal medicine
medicine
Humans
Cardiac Surgical Procedures
Referral and Consultation
business.industry
Hazard ratio
Cardiac Pacing, Artificial
Cardiomyopathy, Hypertrophic
Middle Aged
Calcium Channel Blockers
medicine.disease
Confidence interval
Management strategy
Treatment Outcome
Cardiology
Female
Obstructive hypertrophic cardiomyopathy
Cardiology and Cardiovascular Medicine
Disopyramide
business
human activities
Algorithms
Follow-Up Studies
medicine.drug
Subjects
Details
- ISSN :
- 00029149
- Volume :
- 110
- Database :
- OpenAIRE
- Journal :
- The American Journal of Cardiology
- Accession number :
- edsair.doi.dedup.....8af18d118925ac7e9286da215fbfb335