The following is a summary of “Survival After Septal Reduction in Patients >65 Years Old With Obstructive Hypertrophic Cardiomyopathy,” published in the January 2023 issue of Cardiology by Mentias, et al.

The diagnosis of obstructive hypertrophic cardiomyopathy (oHCM) in older people is rising. The long-term effects of septal reduction treatments (SRT) in Medicare patients with oHCM and the relationship between hospital volume and the result were the subjects of the authors’ research.

They identified Medicare members >65 years who received SRT, septal myectomy (SM), or alcohol septal ablation (ASA) between 2013 and 2019. All-cause mortality was the primary endpoint, while heart failure (HF) readmission and the requirement for repeat SRT during follow-up were secondary outcomes. In order to account for variations between the two groups, overlap propensity score weighting was applied. The study looked at the relationship between hospital SRT volume and both short- and long-term mortality.

Women made up 67.2% vs. 71.1% of the study’s 5,679 oHCM patients (SM = 3,680 and ASA = 1,999, mean age 72.9 vs. 74.8 years; P< 0.01). Although SM patients had fewer comorbidities, both groups were evenly distributed after correction. On landmark analysis, SM was linked to lower mortality after 2 years of follow-up (HR: 0.72; 95% CI: 0.60-0.87; P< 0.001) and had a lower need for redo SRT, even though there was no difference in long-term mortality between SM and ASA (HR: 0.87; 95% CI: 0.74-1.03; P = 0.1) at 4 years (IQR: 2-6 years). Both decreased the number of HF readmissions throughout the follow-up period compared to the year before SRT. Although 70% of SRT procedures were carried out in low-volume clinics, higher-volume centers had better results than lower-volume centers.

SRT decreased the risk of HF readmission in oHCM patients on Medicare. In comparison to ASA, SM was linked to a reduced rate of redo and greater long-term survival. Despite having better results, 70% of SRT procedures were carried out at low-volume U.S. institutions.

Reference: jacc.org/doi/10.1016/j.jacc.2022.10.027