Access Challenges for Septal Reduction Therapy Among Individuals With Obstructive Hypertrophic Cardiomyopathy.

BACKGROUND

In symptomatic patients with treatment-refractory obstructive hypertrophic cardiomyopathy, septal reduction therapy (SRT) is recommended to relieve obstruction. This study examined the challenges associated with SRT access in the United States.

METHODS

Cross-sectional study of commercially insured individuals or Medicare Advantage with Part D members captured in the Optum Research Database from May 2012 to April 2022. Patients with obstructive hypertrophic cardiomyopathy who underwent SRT were identified based on diagnosis/procedure codes. Treatment center procedural volume was defined based on tertiles. SRT access was assessed by the distance patients traveled to care and the proportion of patients treated at hypertrophic cardiomyopathy centers of excellence (COE) by region. Cohorts of patients with coronary artery disease who underwent percutaneous coronary intervention or coronary artery bypass grafting were compared with the SRT cohort.

RESULTS

Overall, 1864 patients who underwent SRT, 235 652 with percutaneous coronary intervention, and 69 236 with coronary artery bypass grafting were included. In the SRT cohort, 368 patients (19.7%) underwent procedures at COE. A greater proportion of patients who traveled long distances for care (≥50 miles) underwent SRT at COE (35.7%) or high-volume facilities (43.8%) than those who traveled short distances (0-<10 miles; 13.3% and 28.1%, respectively). Mean distance to care was longer for the SRT cohort than the percutaneous coronary intervention/coronary artery bypass grafting cohorts. Among US regions, the proportion of patients who underwent SRT at standard centers versus COE was highest in the South (87.5% versus 12.5%).

CONCLUSIONS

Patients traveled long distances for SRT at COE/high-volume centers. Most patients received SRT at standard centers rather than at COE.