Understanding Trends in Hypertrophic Cardiomyopathy-Related ED Visits, with Ahmad Masri, MD, MS

Insights from an analysis of the Nationwide Emergency Department Sample (NEDS) from 2006 through 2019 provides a snapshot of trends in emergency department visits among patients with hypertrophic cardiomyopathy (HCM) in the US.

Presented at the American College of Cardiology 2024 (ACC.24) Annual Scientific Session, results of the study serve as a testament to the growing recognition of HCM, but also the need for a greater emphasis on optimal management, with data showing the number of HCM-related emergency department visits increased throughout the study period, but the rate of those presenting with cardiac arrest remained stable.

“What we saw is that while there was a 4 times increase in the number of emergency department visits and emergency department utilization, the number of incidences of sudden deaths and cardiac arrest that are presenting to the emergency room… is stable,” said senior investigator Ahmad Masri, MD, MS, director of the Hypertrophic Cardiomyopathy Center at Oregon Health and Science University, in an interview with HCPLive. “So, you could say, ‘Yay, this is working, and the incidence is stable’. Or you could say, ‘Well, I thought that the incidence should be actually going down, because if we are managing patients better and we are having better recognition, why is the proportion still stable there?’.”

The study was conducted by Masri and colleagues at Oregon Health and Science University Knight Cardiovascular Institute to develop a better understanding of the rapidly changing epidemiology of HCM in the US. With this in mind, investigators designed their analysis of NEDS data with trends in the rate of death and patient disposition from the emergency department vistas at the outcomes of interest.

From 2006 through 2019, investigators identified 355,548 HCM-related emergency department visits for inclusion in their analysis. Initial analysis suggested the proportion of emergency department visits with HCM diagnoses increased from 14,974 (0.01%) in 2006 to 53,463 (0.04%) in 2019. Among the 355,548 visits included in the study, 23,371 (6.6%) patients presented with cardiac arrest and 9358 (2.6%) died.

Further analysis indicated proportion of cardiac arrests among HCM ED visits from 2006 through 2019 was stable (P value for trend =.6276). Among the 9358 who died, 2618 (27.9%) patients presented with cardiac arrest. Upon analysis of this subgroup, 2318 (88.5%) died as inpatients and 300 (11.5%) died in the emergency department.

Investigators pointed out there was a positive uptrend in the proportion of HCM-related deaths who died with cardiac arrest as inpatient from 520 (18.7%) in 2006 to 1324 (29.4%) in 2017, but no change was observed in the trend of HCM-related deaths with cardiac arrest in the emergency department.

For more on the results of this study check out our interview with Masri from the conference floor at ACC.24.

Relevant disclosures for Masri include Cytokinetics, Bristol Myers Squibb, Eidos, Pfizer, Ionis, Lexicon, AstraZeneca, Tenaya, and others.

References:

Sapru A, Altibi A, Elman M, Masri A. DEATH TRENDS IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY IN EMERGENCY DEPARTMENTS IN THE UNITED STATES. Presented at: American College of Cardiology (ACC.24) Annual Scientific Session. April 6 – 8, 2024. Atlanta, GA.