Characteristics of Patients With Obstructive Hypertrophic Cardiomyopathy in Real-World Community-Based Cardiovascular Practices

The clinical profile of patients with obstructive hypertrophic cardiomyopathy (oHC) is not well characterized, with little evidence outside selected referral populations. Using longitudinal medical claims data from a United States nationwide database, we retrospectively identified adults who were newly diagnosed with oHC. Clinical characteristics were compared from 1 year before diagnosis and at the 2-year follow-up. Patients (N = 1,841) with oHC (age 63 ± 15 years; 52% were male) with geographic representation across the United States were identified. Most patients received care within community-based cardiovascular practices and 7% at referral hypertrophic cardiomyopathy (HC) centers. Baseline diagnostic procedures included electrocardiogram (66%), echocardiogram (51%), magnetic resonance imaging (4%), and HC genetic testing (0.7%). Baseline co-morbidities were hypertension (59%), coronary artery disease (30%), diabetes (19%), and atrial fibrillation (19%). For all HC-related medications, use significantly increased after diagnosis. During follow-up, 144 patients (8%) received an implantable cardioverter-defibrillator for sudden death prevention, 99 underwent septal myectomy (5%), and 24 underwent alcohol septal ablation (1%). By the 1-year follow-up, 2% of patients had sudden cardiac arrest and 26% had atrial fibrillation, and heart failure increased from 16% to 27%. In conclusion, in a community-based population of patients with oHC, patients’ age at diagnosis of oHC was older than reported for referral populations and patients had a significant co-morbidity burden. Cardiovascular medication use was appropriate, but the rate of guideline-supported surgical procedures was low. The clinical profile of patients with obstructive hypertrophic cardiomyopathy (oHC) is not well characterized, with little evidence outside selected referral populations. Using longitudinal medical claims data from a United States nationwide database, we retrospectively identified adults who were newly diagnosed with oHC. Clinical characteristics were compared from 1 year before diagnosis and at the 2-year follow-up. Patients (N = 1,841) with oHC (age 63 ± 15 years; 52% were male) with geographic representation across the United States were identified. Most patients received care within community-based cardiovascular practices and 7% at referral hypertrophic cardiomyopathy (HC) centers. Baseline diagnostic procedures included electrocardiogram (66%), echocardiogram (51%), magnetic resonance imaging (4%), and HC genetic testing (0.7%). Baseline co-morbidities were hypertension (59%), coronary artery disease (30%), diabetes (19%), and atrial fibrillation (19%). For all HC-related medications, use significantly increased after diagnosis. During follow-up, 144 patients (8%) received an implantable cardioverter-defibrillator for sudden death prevention, 99 underwent septal myectomy (5%), and 24 underwent alcohol septal ablation (1%). By the 1-year follow-up, 2% of patients had sudden cardiac arrest and 26% had atrial fibrillation, and heart failure increased from 16% to 27%. In conclusion, in a community-based population of patients with oHC, patients’ age at diagnosis of oHC was older than reported for referral populations and patients had a significant co-morbidity burden. Cardiovascular medication use was appropriate, but the rate of guideline-supported surgical procedures was low. Previous studies of patients with obstructive hypertrophic cardiomyopathy (oHC) that were representative of selected referral populations showed low incidence of cardiovascular adverse events, mortality, and normal longevity owing to contemporary treatments.1Gersh BJ Maron BJ Bonow RO Dearani JA Fifer MA Link MS Naidu SS Nishimura RA Ommen SR Rakowski H Seidman CE Towbin JA Udelson JE Yancy CW American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American Society of Echocardiography; American Society of Nuclear Cardiology; Heart Failure Society of America; Heart Rhythm Society; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Circulation. 2011; 124: 2761-2796Crossref PubMed Scopus (610) Google Scholar, 2Maron BJ Rowin EJ Casey SA Link MS Lesser JR Chan RH Garberich RF Udelson JE Maron MS. Hypertrophic cardiomyopathy in adulthood associated with low cardiovascular mortality with contemporary management strategies.J Am Coll Cardiol. 2015; 65: 1915-1928Crossref PubMed Scopus (197) Google Scholar, 3Maron MS Rowin EJ Wessler BS Mooney PJ Fatima A Patel P Koethe BC Romashko M Link MS Maron BJ. Enhanced American College of Cardiology/American Heart Association strategy for prevention of sudden cardiac death in high-risk patients with hypertrophic cardiomyopathy.JAMA Cardiol. 2019; 4: 644-657Crossref PubMed Scopus (148) Google Scholar, 4Desai MY Bhonsale A Smedira NG Naji P Thamilarasan M Lytle BW Lever HM. Predictors of long-term outcomes in symptomatic hypertrophic obstructive cardiomyopathy patients undergoing surgical relief of left ventricular outflow tract obstruction.Circulation. 2013; 128: 209-216Crossref PubMed Scopus (140) Google Scholar, 5Ommen SR Maron BJ Olivotto I Maron MS Cecchi F Betocchi S Gersh BJ Ackerman MJ McCully RB Dearani JA Schaff HV Danielson GK Tajik AJ Nishimura RA. Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy.J Am Coll Cardiol. 2005; 46: 470-476Crossref PubMed Scopus (589) Google Scholar, 6Maron BJ Ommen SR P Olivotto I Maron MS. Hypertrophic cardiomyopathy: and with contemporary cardiovascular Am Coll Cardiol. in Am Coll PubMed Scopus Google Scholar, H Rowin EJ Udelson JE P Maron BJ Maron MS of surgical septal myectomy for obstructive hypertrophic cardiomyopathy: the PubMed Scopus Google is evidence on characteristics and outcomes of patients with oHC in cardiovascular outside of referral centers. from patients with oHC from a database, a population from across the United States evidence to the hypertrophic cardiomyopathy (HC) on management outside of selected populations and a nationwide to the with was a longitudinal and medical claims data from the to a to 2015; that were the of The is a and of longitudinal medical and claims data from across the United and to a to 2015; The claims for of the populations in the United States and data on medical care and and to a to 2015; patients were identified from the to a to 2015; on the of a of medical and claims data The patients included in had medical for oHC of Clinical of with on of and on diagnosis The of a diagnosis for oHC was the of oHC patients were to claims with a diagnosis of oHC the In patients had to had medical and of before and after the Patients who had a oHC diagnosis in the were from the to on newly diagnosed patients with oHC. The was the before the of The and 2-year were the and after the were The included characteristics geographic on the and clinical characteristics and of the and and 2-year were to and were for and and were for the use of HC-related and were reported for the year and the and 2-year after oHC diagnosis. The and of patients with were reported were the of ± of HC-related medication patients identified with oHC, the age was 63 and were Patients were from the but was representation across the United States geographic Most patients with oHC received care within a community-based cardiovascular with 7% had an at referral HC centers. The was (66%), of patients had and Most patients were diagnosed a and the of patients with diagnostic procedures and cardiac imaging increased the 2-year with oHC (N = and year care and was for of oHC = obstructive hypertrophic = and The was for of = obstructive hypertrophic = in a for patients with oHC (N = = = = = magnetic resonance = increased from in the year after diagnosis of oHC increased from to 2-year for all HC-related medications, with patients on During 2-year follow-up, 144 patients (8%) underwent implantable cardioverter-defibrillator for sudden death prevention and underwent heart In the 99 patients underwent septal myectomy and 24 patients underwent alcohol septal with from oHC diagnosis to of and surgical at 2-year implantable (4%), procedures coronary and implantable cardiac (0.7%). By the 1-year follow-up, sudden cardiac arrest had in 2% of patients and atrial fibrillation in and heart failure had increased from 16% to in patients with oHC (N = claims were for diagnosis of = coronary artery = = diabetes = = = = ventricular medication = outcomes (N = longitudinal data to a of patients with oHC from the population in the United States and characteristics and Most patients were from referral and age at on was Patients had a significant of cardiovascular was use of cardiovascular medication but low incidence of surgical septal myectomy alcohol septal and surgical with studies of patients with oHC data from the that all procedures in the United SS A Patel A S Patel P M A A M of ventricular septal myectomy and hypertrophic cardiomyopathy Cardiol. PubMed Scopus Google Scholar, A SS Patel Patel S A ablation and hypertrophic obstructive cardiomyopathy: Cardiol. PubMed Scopus Google Scholar, P Naidu SS outcomes after septal myectomy and alcohol septal ablation for treatment of obstructive hypertrophic cardiomyopathy: Cardiol. PubMed Scopus Google and of patients with HC from selected referral S P MY P P M Maron MS H in hypertrophic cardiomyopathy in the Am Coll Cardiol. 2019; PubMed Scopus Google M F M Olivotto I of age at diagnosis in hypertrophic cardiomyopathy: an of the cardiomyopathy Heart PubMed Scopus Google patients in were older at the of diagnosis and were age at diagnosis in a HC in patients with significant and patients at for sudden cardiac death to to an HC In the of co-morbidities atrial fibrillation, ventricular heart and HC-related medication for were than in the SS A Patel A S Patel P M A A M of ventricular septal myectomy and hypertrophic cardiomyopathy Cardiol. PubMed Scopus Google P Naidu SS outcomes after septal myectomy and alcohol septal ablation for treatment of obstructive hypertrophic cardiomyopathy: Cardiol. PubMed Scopus Google S P MY P P M Maron MS H in hypertrophic cardiomyopathy in the Am Coll Cardiol. 2019; PubMed Scopus Google In of patients with oHC (N = selected for septal ablation reported of A H after alcohol septal ablation for hypertrophic cardiomyopathy the Cardiol. PubMed Scopus Google the patients were older than the The rate of sudden cardiac death in was low and to the rate reported a of patients with HC in a EJ Maron MS Maron BJ. Hypertrophic cardiomyopathy in Cardiol. PubMed Scopus Google the received patients with oHC in the of HC-related after diagnosis to the rate of surgical procedures for treatment of oHC was than in a EJ Maron MS Maron BJ. Hypertrophic cardiomyopathy in Cardiol. PubMed Scopus Google and studies of the SS A Patel A S Patel P M A A M of ventricular septal myectomy and hypertrophic cardiomyopathy Cardiol. PubMed Scopus Google Scholar, A SS Patel Patel S A ablation and hypertrophic obstructive cardiomyopathy: Cardiol. PubMed Scopus Google Scholar, P Naidu SS outcomes after septal myectomy and alcohol septal ablation for treatment of obstructive hypertrophic cardiomyopathy: Cardiol. PubMed Scopus Google patients and significant in referral populations for the of septal and cardioverter-defibrillator in that for patients who septal from diagnosis to the was a of diagnosis in the a of the of not for that of septal a to to to oHC, of of a is not EJ Maron MS Maron BJ. Hypertrophic cardiomyopathy in Cardiol. PubMed Scopus Google M F Cecchi F Seidman CE Olivotto and of disease in hypertrophic cardiomyopathy: from the cardiomyopathy PubMed Scopus Google from a representative of community-based patients with oHC with studies that oHC is a and patients to normal Patients with oHC a of co-morbidities and low of guideline-supported surgical the of low in the is and studies the of septal and implantable in patients with oHC in community-based cardiovascular to claims data that to The of the population of in owing to the and of HC in clinical for who P A of hypertrophic cardiomyopathy: of diagnostic PubMed Scopus Google and hypertrophic PubMed Scopus Google of claims on diagnosis not in the of genetic of patients diagnosis on the of is and was on we that patients in we patients with oHC of of before and 24 after the in that to the low of cardiovascular diagnostic of oHC patients were to claims with a diagnosis of oHC that patients were not with a of hypertension in a of claims not clinical data and we had to that HC outcomes were to HC and not a of conclusion, in a community-based patients with oHC at diagnosis on in with a co-morbidity burden. Cardiovascular medication was appropriate, and septal and surgical procedures were than reported The from diagnosis to septal was use of HC diagnosis in symptomatic patients with oHC in The from the characteristics and management of patients with oHC and to the of of to clinical in the Previous studies of patients with obstructive hypertrophic cardiomyopathy (oHC) that were representative of selected referral populations showed low incidence of cardiovascular adverse events, mortality, and normal longevity owing to contemporary treatments.1Gersh BJ Maron BJ Bonow RO Dearani JA Fifer MA Link MS Naidu SS Nishimura RA Ommen SR Rakowski H Seidman CE Towbin JA Udelson JE Yancy CW American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American Society of Echocardiography; American Society of Nuclear Cardiology; Heart Failure Society of America; Heart Rhythm Society; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Circulation. 2011; 124: 2761-2796Crossref PubMed Scopus (610) Google Scholar, 2Maron BJ Rowin EJ Casey SA Link MS Lesser JR Chan RH Garberich RF Udelson JE Maron MS. Hypertrophic cardiomyopathy in adulthood associated with low cardiovascular mortality with contemporary management strategies.J Am Coll Cardiol. 2015; 65: 1915-1928Crossref PubMed Scopus (197) Google Scholar, 3Maron MS Rowin EJ Wessler BS Mooney PJ Fatima A Patel P Koethe BC Romashko M Link MS Maron BJ. Enhanced American College of Cardiology/American Heart Association strategy for prevention of sudden cardiac death in high-risk patients with hypertrophic cardiomyopathy.JAMA Cardiol. 2019; 4: 644-657Crossref PubMed Scopus (148) Google Scholar, 4Desai MY Bhonsale A Smedira NG Naji P Thamilarasan M Lytle BW Lever HM. Predictors of long-term outcomes in symptomatic hypertrophic obstructive cardiomyopathy patients undergoing surgical relief of left ventricular outflow tract obstruction.Circulation. 2013; 128: 209-216Crossref PubMed Scopus (140) Google Scholar, 5Ommen SR Maron BJ Olivotto I Maron MS Cecchi F Betocchi S Gersh BJ Ackerman MJ McCully RB Dearani JA Schaff HV Danielson GK Tajik AJ Nishimura RA. Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy.J Am Coll Cardiol. 2005; 46: 470-476Crossref PubMed Scopus (589) Google Scholar, 6Maron BJ Ommen SR P Olivotto I Maron MS. Hypertrophic cardiomyopathy: and with contemporary cardiovascular Am Coll Cardiol. in Am Coll PubMed Scopus Google Scholar, H Rowin EJ Udelson JE P Maron BJ Maron MS of surgical septal myectomy for obstructive hypertrophic cardiomyopathy: the PubMed Scopus Google is evidence on characteristics and outcomes of patients with oHC in cardiovascular outside of referral centers. from patients with oHC from a database, a population from across the United States evidence to the hypertrophic cardiomyopathy (HC) on management outside of selected populations and a nationwide to the with oHC. was a longitudinal and medical claims data from the to a to 2015; that were the of The is a and of longitudinal medical and claims data from across the United and to a to 2015; The claims for of the populations in the United States and data on medical care and and to a to 2015; patients were identified from the to a to 2015; on the of a of medical and claims data The patients included in had medical for oHC of Clinical of with on of and on diagnosis The of a diagnosis for oHC was the of oHC patients were to claims with a diagnosis of oHC the In patients had to had medical and of before and after the Patients who had a oHC diagnosis in the were from the to on newly diagnosed patients with oHC. The was the before the of The and 2-year were the and after the were The included characteristics geographic on the and clinical characteristics and of the and and 2-year were to and were for and and were for the use of HC-related and were reported for the year and the and 2-year after oHC diagnosis. The and of patients with were reported were the of ± of HC-related medication was a longitudinal and medical claims data from the to a to 2015; that were the of The is a and of longitudinal medical and claims data from across the United and to a to 2015; The claims for of the populations in the United States and data on medical care and and to a to 2015; patients were identified from the to a to 2015; on the of a of medical and claims data The patients included in had medical for oHC of Clinical of with on of and on diagnosis The of a diagnosis for oHC was the of oHC patients were to claims with a diagnosis of oHC the In patients had to had medical and of before and after the Patients who had a oHC diagnosis in the were from the to on newly diagnosed patients with oHC. The was the before the of The and 2-year were the and after the were The included characteristics geographic on the and clinical characteristics and of the and and 2-year were to and were for and and were for the use of HC-related and were reported for the year and the and 2-year after oHC diagnosis. The and of patients with were reported were the of ± of HC-related medication patients identified with oHC, the age was 63 and were Patients were from the but was representation across the United States geographic Most patients with oHC received care within a community-based cardiovascular with 7% had an at referral HC centers. The was (66%), of patients had and Most patients were diagnosed a and the of patients with diagnostic procedures and cardiac imaging increased the 2-year with oHC (N = and year care and was for of oHC = obstructive hypertrophic = and The was for of = obstructive hypertrophic = in a increased from in the year after diagnosis of oHC increased from to 2-year for all HC-related medications, with patients on During 2-year follow-up, 144 patients (8%) underwent implantable cardioverter-defibrillator for sudden death prevention and underwent heart In the 99 patients underwent septal myectomy and 24 patients underwent alcohol septal with from oHC diagnosis to of and surgical at 2-year implantable (4%), procedures coronary and implantable cardiac (0.7%). By the 1-year follow-up, sudden cardiac arrest had in 2% of patients and atrial fibrillation in and heart failure had increased from 16% to in patients with oHC (N = claims were for diagnosis of = coronary artery = = diabetes = = = = ventricular medication = outcomes (N = patients identified with oHC, the age was 63 and were Patients were from the but was representation across the United States geographic Most patients with oHC received care within a community-based cardiovascular with 7% had an at referral HC centers. The was (66%), of patients had and Most patients were diagnosed a and the of patients with diagnostic procedures and cardiac imaging increased the 2-year increased from in the year after diagnosis of oHC increased from to 2-year for all HC-related medications, with patients on During 2-year follow-up, 144 patients (8%) underwent implantable cardioverter-defibrillator for sudden death prevention and underwent heart In the 99 patients underwent septal myectomy and 24 patients underwent alcohol septal with from oHC diagnosis to of and surgical at 2-year implantable (4%), procedures coronary and implantable cardiac (0.7%). By the 1-year follow-up, sudden cardiac arrest had in 2% of patients and atrial fibrillation in and heart failure had increased from 16% to longitudinal data to a of patients with oHC from the population in the United States and characteristics and Most patients were from referral and age at on was Patients had a significant of cardiovascular was use of cardiovascular medication but low incidence of surgical septal myectomy alcohol septal and surgical with studies of patients with oHC data from the that all procedures in the United SS A Patel A S Patel P M A A M of ventricular septal myectomy and hypertrophic cardiomyopathy Cardiol. PubMed Scopus Google Scholar, A SS Patel Patel S A ablation and hypertrophic obstructive cardiomyopathy: Cardiol. PubMed Scopus Google Scholar, P Naidu SS outcomes after septal myectomy and alcohol septal ablation for treatment of obstructive hypertrophic cardiomyopathy: Cardiol. PubMed Scopus Google and of patients with HC from selected referral S P MY P P M Maron MS H in hypertrophic cardiomyopathy in the Am Coll Cardiol. 2019; PubMed Scopus Google M F M Olivotto I of age at diagnosis in hypertrophic cardiomyopathy: an of the cardiomyopathy Heart PubMed Scopus Google patients in were older at the of diagnosis and were age at diagnosis in a HC in patients with significant and patients at for sudden cardiac death to to an HC In the of co-morbidities atrial fibrillation, ventricular heart and HC-related medication for were than in the SS A Patel A S Patel P M A A M of ventricular septal myectomy and hypertrophic cardiomyopathy Cardiol. PubMed Scopus Google P Naidu SS outcomes after septal myectomy and alcohol septal ablation for treatment of obstructive hypertrophic cardiomyopathy: Cardiol. PubMed Scopus Google S P MY P P M Maron MS H in hypertrophic cardiomyopathy in the Am Coll Cardiol. 2019; PubMed Scopus Google In of patients with oHC (N = selected for septal ablation reported of A H after alcohol septal ablation for hypertrophic cardiomyopathy the Cardiol. PubMed Scopus Google the patients were older than the The rate of sudden cardiac death in was low and to the rate reported a of patients with HC in a EJ Maron MS Maron BJ. Hypertrophic cardiomyopathy in Cardiol. PubMed Scopus Google the received patients with oHC in the of HC-related after diagnosis to the rate of surgical procedures for treatment of oHC was than in a EJ Maron MS Maron BJ. Hypertrophic cardiomyopathy in Cardiol. PubMed Scopus Google and studies of the SS A Patel A S Patel P M A A M of ventricular septal myectomy and hypertrophic cardiomyopathy Cardiol. PubMed Scopus Google Scholar, A SS Patel Patel S A ablation and hypertrophic obstructive cardiomyopathy: Cardiol. PubMed Scopus Google Scholar, P Naidu SS outcomes after septal myectomy and alcohol septal ablation for treatment of obstructive hypertrophic cardiomyopathy: Cardiol. PubMed Scopus Google patients and significant in referral populations for the of septal and cardioverter-defibrillator in that for patients who septal from diagnosis to the was a of diagnosis in the a of the of not for that of septal a to to to oHC, of of a is not EJ Maron MS Maron BJ. Hypertrophic cardiomyopathy in Cardiol. PubMed Scopus Google M F Cecchi F Seidman CE Olivotto and of disease in hypertrophic cardiomyopathy: from the cardiomyopathy PubMed Scopus Google from a representative of community-based patients with oHC with studies that oHC is a and patients to normal Patients with oHC a of co-morbidities and low of guideline-supported surgical the of low in the is and studies the of septal and implantable in patients with oHC in community-based cardiovascular to claims data that to The of the population of in owing to the and of HC in clinical for who P A of hypertrophic cardiomyopathy: of diagnostic PubMed Scopus Google and hypertrophic PubMed Scopus Google of claims on diagnosis not in the of genetic of patients diagnosis on the of is and was on we that patients in we patients with oHC of of before and 24 after the in that to the low of cardiovascular diagnostic of oHC patients were to claims with a diagnosis of oHC that patients were not with a of hypertension in a of claims not clinical data and we had to that HC outcomes were to HC and not a of conclusion, in a community-based patients with oHC at diagnosis on in with a co-morbidity burden. Cardiovascular medication was appropriate, and septal and surgical procedures were than reported The from diagnosis to septal was use of HC diagnosis in symptomatic patients with oHC in The from the characteristics and management of patients with oHC and to the of of to clinical in the longitudinal data to a of patients with oHC from the population in the United States and characteristics and Most patients were from referral and age at on was Patients had a significant of cardiovascular was use of cardiovascular medication but low incidence of surgical septal myectomy alcohol septal and surgical with studies of patients with oHC data from the that all procedures in the United SS A Patel A S Patel P M A A M of ventricular septal myectomy and hypertrophic cardiomyopathy Cardiol. PubMed Scopus Google Scholar, A SS Patel Patel S A ablation and hypertrophic obstructive cardiomyopathy: Cardiol. PubMed Scopus Google Scholar, P Naidu SS outcomes after septal myectomy and alcohol septal ablation for treatment of obstructive hypertrophic cardiomyopathy: Cardiol. PubMed Scopus Google and of patients with HC from selected referral S P MY P P M Maron MS H in hypertrophic cardiomyopathy in the Am Coll Cardiol. 2019; PubMed Scopus Google M F M Olivotto I of age at diagnosis in hypertrophic cardiomyopathy: an of the cardiomyopathy Heart PubMed Scopus Google patients in were older at the of diagnosis and were age at diagnosis in a HC in patients with significant and patients at for sudden cardiac death to to an HC In the of co-morbidities atrial fibrillation, ventricular heart and HC-related medication for were than in the SS A Patel A S Patel P M A A M of ventricular septal myectomy and hypertrophic cardiomyopathy Cardiol. PubMed Scopus Google P Naidu SS outcomes after septal myectomy and alcohol septal ablation for treatment of obstructive hypertrophic cardiomyopathy: Cardiol. PubMed Scopus Google S P MY P P M Maron MS H in hypertrophic cardiomyopathy in the Am Coll Cardiol. 2019; PubMed Scopus Google In of patients with oHC (N = selected for septal ablation reported of A H after alcohol septal ablation for hypertrophic cardiomyopathy the Cardiol. PubMed Scopus Google the patients were older than the The rate of sudden cardiac death in was low and to the rate reported a of patients with HC in a EJ Maron MS Maron BJ. Hypertrophic cardiomyopathy in Cardiol. PubMed Scopus Google the received patients with oHC in the of HC-related after diagnosis to the rate of surgical procedures for treatment of oHC was than in a EJ Maron MS Maron BJ. Hypertrophic cardiomyopathy in Cardiol. PubMed Scopus Google and studies of the SS A Patel A S Patel P M A A M of ventricular septal myectomy and hypertrophic cardiomyopathy Cardiol. PubMed Scopus Google Scholar, A SS Patel Patel S A ablation and hypertrophic obstructive cardiomyopathy: Cardiol. PubMed Scopus Google Scholar, P Naidu SS outcomes after septal myectomy and alcohol septal ablation for treatment of obstructive hypertrophic cardiomyopathy: Cardiol. PubMed Scopus Google patients and significant in referral populations for the of septal and cardioverter-defibrillator in that for patients who septal from diagnosis to the was a of diagnosis in the a of the of not for that of septal a to to to oHC, of of a is not EJ Maron MS Maron BJ. Hypertrophic cardiomyopathy in Cardiol. PubMed Scopus Google M F Cecchi F Seidman CE Olivotto and of disease in hypertrophic cardiomyopathy: from the cardiomyopathy PubMed Scopus Google from a representative of community-based patients with oHC with studies that oHC is a and patients to normal Patients with oHC a of co-morbidities and low of guideline-supported surgical the of low in the is and studies the of septal and implantable in patients with oHC in community-based cardiovascular to claims data that to The of the population of in owing to the and of HC in clinical for who P A of hypertrophic cardiomyopathy: of diagnostic PubMed Scopus Google and hypertrophic PubMed Scopus Google of claims on diagnosis not in the of genetic of patients diagnosis on the of is and was on we that patients in we patients with oHC of of before and 24 after the in that to the low of cardiovascular diagnostic of oHC patients were to claims with a diagnosis of oHC that patients were not with a of hypertension in a of claims not clinical data and we had to that HC outcomes were to HC and not a of In conclusion, in a community-based patients with oHC at diagnosis on in with a co-morbidity burden. Cardiovascular medication was appropriate, and septal and surgical procedures were than reported The from diagnosis to septal was use of HC diagnosis in symptomatic patients with oHC in The from the characteristics and management of patients with oHC and to the of of to clinical in the Rowin to Maron is a at and of is an of and were of at the the was Rowin of to data and not The of for was was of the in and of was the to the for medical and The had of the to the for