Survival After Septal Reduction in Patients >65 Years Old With Obstructive Hypertrophic Cardiomyopathy

BACKGROUND Obstructive hypertrophic cardiomyopathy (oHCM) is increasingly being diagnosed in elderly patients.OBJECTIVES The authors sought to study long-term outcomes of septal reduction therapies (SRT) in Medicare patients with oHCM, and hospital volume-outcome relation.METHODS Medicare beneficiaries aged >65 years who underwent SRT, septal myectomy (SM) or alcohol septal ablation (ASA), from 2013 through 2019 were identified. Primary outcome was all-cause mortality, and secondary outcomes included heart failure (HF) readmission and need for redo SRT in follow-up. Overlap propensity score weighting was used to adjust for differences between both groups. Relation between hospital SRT volume and short-term and long-term mortality was studied.RESULTS The study included 5,679 oHCM patients (SM = 3,680 and ASA =1,999, mean age 72.9 vs 74.8 years, women 67.2% vs 71.1%; P < 0.01). SM patients had fewer comorbidities, but after adjustment, both groups were well balanced. At 4 years (IQR: 2-6 years), although there was no difference in long-term mortality between SM and ASA (HR: 0.87; 95% CI: 0.74-1.03; P = 0.1), on landmark analysis, SM was associated with lower mortality after 2 years of follow-up (HR: 0.72; 95% CI: 0.60-0.87; P < 0.001) and had lower need for redo SRT. Both reduced HF readmissions in follow-up vs 1 year pre-SRT. Higher-volume centers had better outcomes vs lower-volume centers, but 70% of SRT were performed in low-volume centers.CONCLUSIONS SRT reduced HF readmission in Medicare patients with oHCM. SM is associated with lower redo and better long-term survival compared with ASA. Despite better outcomes in high-volume centers, 70% of SRT are performed in low-volume U.S. centers. (J Am Coll Cardiol 2023;81:105-115)(c) 2023 by the American College of Cardiology Foundation.

Automated summary

This study investigated the long-term outcomes of septal reduction therapies in elderly Medicare patients with oHCM, as well as the relationship between hospital volume and outcomes. The results showed that septal myectomy was associated with lower mortality and need for redo procedures compared to alcohol septal ablation. Additionally, higher-volume centers had better outcomes. However, most patients underwent treatment at low-volume centers.