2024 Guideline for the Management of Hypertrophic Cardiomyopathy

Guidelines for the management of hypertrophic cardiomyopathy (HCM) were recently updated using new methodology to incorporate new evidence-based changes in a more agile time frame. There were a few notable changes; principally, the addition of the cardiac myosin inhibitor mavacamten as an option for patients with symptomatic obstructive HCM who have not responded to first-line therapies. Mavacamten can be considered along with the other class 1 therapeutic options, including surgical septal myectomy, percutaneous septal ablation, or disopyramide. The benefits, risks, logistics, and expectations of each of these options should be discussed with patients in the context of shared decision–making.

Another highlighted change is an evolution in the recommendations for physical activity in patients with HCM. While low- to moderate-intensity exercise as part of a healthy lifestyle was previously noted as a class 1 recommendation, the new guidelines now include a class 2a recommendation that more vigorous exercise (6 Mets for at least 60 min/week) is reasonable for many patients with HCM. With respect to competitive sports, the writing committee felt that the decision to participate remained a class 2b option for athletes but specifically called out that automatic disqualification from competitive sports simply because the individual has HCM was not appropriate and, thus, gave a class 3 recommendation (no benefit) against such a priori disqualifications.

Other changes include refinements to sudden cardiac death risk assessments in children and adolescents, exercise testing in children and adolescents, and risk assessments for atrial fibrillation that might lead to more frequent arrhythmia monitoring.

The writing committee expects 1) future data to address the gaps in the management of nonobstructive HCM, 2) further evolution of sudden cardiac death risk assessment, and 3) optimization of cardiac myosin inhibitors based on real-world experiences.