Septal reduction reduces HF readmission, improves survival in oHCM patients

Septal reduction therapies (SRT) lower the readmission rates for heart failure (HF) in Medicare patients with obstructive hypertrophic cardiomyopathy (oHCM), a study has shown.

Furthermore, septal myectomy (SM) reduces the need for redo SRT and improves long-term survival relative to alcohol septal ablation (ASA).

A group of researchers identified Medicare beneficiaries aged >65 years who underwent SRT, SM, or ASA from 2013 through 2019. All-cause mortality was the primary outcome, while secondary ones included HF readmission and need for redo SRT in follow-up.

The researchers used overlap propensity score weighting to adjust for differences between groups. They also analysed the association of hospital SRT volume with short- and long-term mortality.

A total of 5,679 oHCM patients were included (SM: n=3,680; ASA: n=1,999; mean age 72.9 and 74.8 years; 67.2 percent and 71.1 percent women; p<0.01). Fewer comorbidities were noted among SM patients, but both groups were well balanced following adjustment.

Landmark analysis revealed the significant correlation of SM with lower mortality after 2 years of follow-up (hazard ratio [HR], 0.72, 95 percent confidence interval [CI], 0.60‒0.87; p<0.001) and with lower need for redo SRT, although no difference was seen in long-term mortality between SM and ASA (HR, 0.87, 95 percent CI, 0.74‒1.03; p=0.01) at 4 years.

Both SM and ASA resulted in lower HF readmissions during follow-up compared with 1 year pre-SRT. In addition, higher-volume centres showed better outcomes than did lower-volume centres, but majority of SRT (70 percent) were performed in low-volume centres.