Risk Stratification and Outcome of Patients with Hypertrophic Cardiomyopathy over 60 Years of Age
Background—Hypertrophic cardiomyopathy (HCM) is prominently associated with risk for sudden death (SD) and disease progression, largely in young patients. Whether patients of more advanced age harbor similar risks is unresolved, often creating clinical dilemmas, particularly in decisions for primary prevention of SD with implantable defibrillators.
Methods and Results—We studied 428 consecutive HCM patients presenting at ≥ 60 years, followed 5.8 ± 4.8 years; 53% were women. Of 428 patients, 279 (65%) survived to ages 73 ± 7 (range 61-96), most of these (n = 245; 88%) with no/mild symptoms, including 135 with ≥ 1 conventional SD risk factors and 50 (37%) with late gadolinium enhancement. Over follow-up, 149 (35%) died at80 ± 8 years, most from non-HCM related causes (n = 133; 31%), including a substantial proportion from non-cardiac disease (n = 54). Sixteen patients (3.7%) had HCM-related mortality events (0.64%/year), including embolic stroke (n = 6), progressive heart failure or transplant (n = 3), postoperative complications (n = 2), arrhythmic SD events (n = 5; 1.2%; 0.20%/year). All-cause mortality was increased in HCM patients ≥ 60 years compared to an age matched U.S. general population, due predominantly to non-HCM-related diseases (p < 0.001; SMR 1.5).
Conclusions—HCM patients surviving into the seventh decade of life are at low risk for disease-related morbidity/mortality, including SD, even with conventional risk factors. These data do not support aggressive prophylactic defibrillator implantation at advanced ages in HCM. Other cardiac or non-cardiac co-morbidities have greater impact on survival than HCM in older patients.
- Received August 17, 2012.
- Accepted December 17, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited