Septal reduction reduces HF readmission, improves survival in oHCM patients

17 Jan 2023
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.