New ACC/AHA Hypertrophic Cardiomyopathy Guideline Encourages Shared Decision-Making

The ACC and the American Heart Association (AHA) have released an updated guideline for managing patients with hypertrophic cardiomyopathy (HCM). The guideline encourages shared decision-making between the clinician and patient as essential when determining treatment course and updates recommendations for sudden cardiac death (SCD) risk assessment and HCM center referrals based on the latest evidence.

The 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients with Hypertrophic Cardiomyopathy, published Nov. 20 in the Journal of the American College of Cardiology and Circulation, updates the previous guideline, which was issued in 2011. The guideline offers recommendations on the evaluation and management of patients with HCM and is geared to cardiovascular clinicians as well as noncardiovascular clinicians.

New recommendations reflect recent evidence about diagnostic modalities such as electrocardiography, imaging and genetic testing; management of patients including medical therapies, septal reduction therapies and SCD risk assessment/prevention; and other considerations such as participation in activities/sports, occupation and pregnancy.

The updated guideline also clarifies the varied treatments that may include medications such as a beta-blocker and/or a calcium channel blocker, a surgical procedure and/or device like an implantable cardioverter defibrillator (ICD). Different from the previous 2011 guideline, the updated guideline emphasizes shared decision-making in the management of HCM to personalize treatment options based on the patient's goals and concerns.

"Shared decision-making, a dialogue between patients and their care team that includes full disclosure of all testing and treatment options, discussion of the risks and benefits of those options and, importantly, engagement of the patient to express their own goals, is particularly relevant in the management of conditions such as hypertrophic cardiomyopathy," said Steve R. Ommen, MD, FACC, chair of the writing committee. "This updated guideline places emphasis on including the patient in the decision-making process rather than simply providing dogmatic lists of do's and don'ts."

While the guideline writers recognize that patients with HCM can be evaluated and treated by a cardiovascular care team, recommendations are made for patients with severe HCM, or those facing complex decisions, to be referred to multidisciplinary HCM centers to receive optimal care.

Guidance around participation in healthy physical activity is also updated to make it clearer that recreational exercise is an option for patients with HCM. According to the updated guideline, participation in competitive sports may also now be considered in selected patients after a complete discussion between patients with HCM and their doctors about the potential risks.

"Increasingly, data affirm that the beneficial effects of exercise on general health can be extended to patients with HCM," Ommen said. "Healthy recreational exercise (moderate intensity) has not been associated with increased risk of ventricular arrhythmia events in recent studies."

Furthering the personalized approach to care, the guideline also includes updated recommendations for assessing individual risk markers for SCD, which can help identify patients who may need an ICD, and counseling patients about the potential genetic transmission of HCM and screening options for family members.

To accompany the guideline, the College has developed several tools and resources including a clinician-focused HCM Guidelines Made Simple Tool and a patient-focused CardioSmart HCM Infographic, that are available on the ACC HCM Guideline Hub. Additionally, don't miss two HCM Guideline-focused case reports in JACC: Case Reports from de Feria, et al., and Kantor, et al. More resources, including an interactive central illustration are available on the JACC.org Guideline Hub.

As a complement to the ACC/AHA Guideline Optimization effort, a new tool on ACC.org was launched to help users more easily search within guidelines. The new search tool can be found at ACC.org/Guidelines.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Sports and Exercise Cardiology, Implantable Devices, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Echocardiography/Ultrasound, Magnetic Resonance Imaging, Nuclear Imaging, Sports and Exercise and ECG and Stress Testing, Sports and Exercise and Imaging

Keywords: Ablation Techniques, Arrhythmias, Cardiac, Electrocardiography, Ambulatory, Atrial Fibrillation, Cardiac Imaging Techniques, Magnetic Resonance Imaging, Cardiovascular Surgical Procedures, Cardiomyopathies, Drug Therapy, Echocardiography, Exercise Test, Medical History Taking, Family, Genetic Diseases, Inborn, Genetics, Hemodynamics, Cardiomyopathy, Hypertrophic, Cardiomyopathy, Hypertrophic, Familial, Diagnostic Imaging, Defibrillators, Implantable, Angiography, Coronary Angiography, Pregnancy, Risk Assessment, Decision Making, Sports, Death, Sudden, Cardiac


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