New ACC/AHA Guideline Focuses on Evaluation and Management of People With HCM

The newest clinical guideline, released May 8 by the ACC and the American Heart Association (AHA), provides the latest evidence-based recommendations for effectively managing individuals diagnosed with hypertrophic cardiomyopathy (HCM).

Updated recommendations in the guideline reflect recent evidence about HCM treatment and management including new forms of pharmacologic management like cardiac myosin inhibitors; participation in vigorous recreational activities and competitive sports; and risk stratification for sudden cardiac death (SCD).

The guideline also underscores the importance of carefully ascertaining family history and having discussions around genetic screening. It addresses the role of multidisciplinary HCM centers, noting that "although the primary cardiology team can initiate evaluation, treatment and longitudinal care," HCM centers "can be important" to optimizing patient care.

Recommendations are also included for managing patients with HCM and persistent or paroxysmal atrial fibrillation, who are at increased risk for stroke. "Because rapid atrial fibrillation is often poorly tolerated in patients with HCM, maintenance of sinus rhythm and rate control are key treatment goals," the guideline states.

Several recommendations in the new guideline also extend to pediatric patients. A specific pediatric risk stratification for SCD is emphasized, with risk calculators specific to children and adolescents and stressing the importance of HCM centers with expertise in pediatrics. The new guideline extends exercise stress testing recommendations to include children diagnosed with HCM to help determine functional capacity and provide prognostic feedback.

"Incorporating the most recent data, this new guideline equips clinicians with the latest recommendations for the treatment of HCM," said Steve R. Ommen, MD, FACC, chair of the guideline writing committee. "We're seeing more evidence that patients with HCM can return to their normal daily lives with proper care and management."

The 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy is published in both JACC and Circulation. In addition to the ACC and the AHA, the guideline was written in collaboration with and endorsed by the American Medical Society for Sports Medicine, the Heart Rhythm Society, the Pediatric & Congenital Electrophysiology Society, and the Society for Cardiovascular Magnetic Resonance.

JACC Central Illustration

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Sports and Exercise Cardiology, Valvular Heart Disease, Implantable Devices, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Echocardiography/Ultrasound, Exercise, Sports and Exercise and ECG and Stress Testing, Sports and Exercise and Imaging

Keywords: Athletes, Atrial Fibrillation, Cardiac Myosins, Echocardiography, Exercise, Exercise Test, Genetics, Hypertrophic Cardiomyopathy, Cardiomyopathy, Hypertrophic, Cardiomyopathy, Hypertrophic, Familial, Defibrillators, Implantable, Ventricular Outflow Obstruction

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