Butzner Michael, Rowin Ethan, Yakubu Amin, Seale Josiah, Robertson Laura A, Sarocco Phil, Maron Martin S
Cytokinetics, Incorporated, Health Economics and Outcomes Research, 350 Oyster Point Blvd, South San Francisco, CA 94080, USA.
Hypertrophic Cardiomyopathy Center and Research Institute, Division of Cardiology, Tufts Medical Center, 860 Washington St Building, Boston, MA 02111, USA.
J Clin Med. 2022 Jul 4;11(13):3898. doi: 10.3390/jcm11133898.
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.
梗阻性肥厚型心肌病（oHCM）主要是在综合卓越中心进行研究。扩大对普通人群中oHCM患者的了解可能会改善其他环境中的识别和治疗。这项回顾性队列研究从一个大型电子病历数据库中识别出患有oHCM的成年人，该数据库包含来自39个综合医疗网络的数据（IBM Explorys；观察期：2009年1月至2019年7月）。报告了临床特征、医疗资源利用（HCRU）和结局。在8791名患者中，53.0%为女性，平均索引年龄为61.8岁。所开的心血管药物包括β受体阻滞剂（80.5%）、钙通道阻滞剂（46.0%）和丙吡胺（2.4%）。随着时间的推移，心力衰竭、心房颤动和室性心律失常有所增加。外科手术包括室间隔心肌切除术（22.0%）、酒精室间隔消融术（0.6%）和心脏移植（0.3%）。11.2%的患者植入了植入式心律转复除颤器。在初始室间隔减容治疗（SRT）后，HCRU增加，550名患者（27.7%）需要再次干预。在整个研究组中，2.7%的患者在研究结束时发生心脏骤停。总之，这组oHCM患者接受了指南推荐的药物治疗和手术。尽管如此，心力衰竭、心房颤动和室性心律失常仍有所增加，超过四分之一接受SRT的患者需要再次干预。这些未解决的问题强调了oHCM患者对新的有效治疗方法的未满足需求。
