Mayo ClinicNew Hypertrophic Cardiomyopathy Clinical Guideline Recommends Novel Drug Therapy and Regular Exercise

New Guidelines Reshape Hypertrophic Cardiomyopathy Management: Balancing Pharmacotherapy and Exercise

The American College of Cardiology (ACC) and the American Heart Association (AHA) have released updated clinical guidelines for hypertrophic cardiomyopathy (HCM) in 2024. These guidelines introduce significant changes in drug therapy recommendations and exercise restrictions, reflecting the latest research and clinical experience in HCM management. The new approach aims to improve patient outcomes while maintaining safety, offering clinicians more options in treating this complex genetic condition.

Key Points:

• The 2024 ACC/AHA guideline for HCM was developed in collaboration with multiple medical societies.
• Cardiac myosin inhibitors are now recommended for symptomatic obstructive HCM patients who don’t respond to first-line medications.
• Mavacamten is currently the only FDA-approved myosin inhibitor for HCM.
• The guideline emphasizes collaborative decision-making and recommends seeking HCM specialists at experienced multidisciplinary centers.
• Regular mild to moderate aerobic exercise is recommended for all asymptomatic HCM patients.
• More vigorous aerobic exercise is now considered reasonable for many HCM patients.
• Strength or resistance exercise is suggested for HCM patients.
• Automatic disqualification from competitive sports is no longer recommended for all HCM patients.
• The guideline refined evaluation and management strategies for children and adolescents with HCM.
• Risk assessment tools are recommended to predict atrial fibrillation in HCM patients.
• Screening for asymptomatic atrial fibrillation is advised for high-risk HCM patients.
• Cardiac myosin inhibitors require special training for clinicians and more frequent patient screenings under the FDA’s REMS program.
• Echocardiographic surveillance is necessary to monitor for left ventricular systolic dysfunction in patients on myosin inhibitors.
• The guideline acknowledges the need for further research on myosin inhibitor therapy, including its long-term effects and potential applications in nonobstructive HCM.

“It’s great to have a new tool in the tool belt for managing HCM. Myosin inhibition therapy will help patients, but it’s not right for everyone. Some patients may still choose septal reduction therapy (myectomy or alcohol septal ablation) instead.”
— Dr. Jeffrey B. Geske, a cardiologist who leads hypertrophic cardiomyopathy research efforts at Mayo Clinic in Minnesota

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