Abstract 13620: Highlights From National Inpatient Sample 2016-2020: Temporal Trends in Septal Reduction Therapy in Hypertrophic Cardiomyopathy

Introduction: Surgical myectomy (SM) and Alcohol septal ablation (ASA) are used for septal reduction therapy (SRT) in obstructive hypertrophic cardiomyopathy (oHCM). Selection criteria, local expertise, and reported outcomes for choice of SM versus ASA have evolved in recent years. We aimed to compare recent temporal trends of SM and ASA.

Methods: National Inpatient Sample 2016-2020 was queried to identify adults with oHCM using appropriate ICD codes along with procedure codes for ASA and SM. oHCM patients were divided into two groups- SM and ASA. Logistic regression was used to compare in-hospital outcomes.

Results: Between 2016 and 2020, there were 5445 cases of SM and 1955 cases with ASA. Cases with ASA were older (67.5 -vs- 59.7 years), more likely to be females (67.3% -vs- 56.3%, p<0.001), and had higher proportion of African Americans (12% -vs- 7%, p<0.001). An overall downward trend in number of SM procedures and an increase in ASA procedures from 2016 to 2020 was observed as listed in Table 1. There were lower number of SM procedures compared to ASA in 2020. While total number of SRT remained relatively stable, proportion of ASA increased in all regions (West, South, Northeast) except Midwest. Urban teaching hospitals continued to perform >90% of SRTs each year and mortality was significantly higher in non-teaching compared to urban teaching hospitals for both SM (8.9% -vs- 2.3%, p<0.01) and ASA (5.6%-vs-1.9%, p<0.01). Major complications were uncommon and did not change during the study period for both procedures.

Conclusions: This retrospective database of hospital admissions for SRT indicates that there was a decline in proportion of patients that underwent SM for oHCM between 2016 and 2020 in most regions of the United States. Further studies are needed to determine the impact of this trend on long-term outcomes of patients with oHCM.