The best of both worlds: a nursing & medical hybrid model delivering patient centred care in a structured cardiac myosin inhibitor clinic
H Hayes, S Edwards, V PatelAbstract
Background/Introduction
Mavacamten, a cardiac myosin inhibitor, reduces LVOT obstruction and improves symptoms in obstructive hypertrophic cardiomyopathy. Its use requires close monitoring and dose adjustment based on symptoms, systolic function and LVOT gradient.
Objectives/Aims
To assess outcomes of a hybrid nurse-led and cardiologist-supervised Mavacamten clinic.
Methods/Intervention/Activity
Cardiologists initiated Mavacamten in person and referred patients for nurse-led telehealth follow-up. Review of focussed echocardiograms and dose titration were performed in partnership with a cardiologist.
Results/Outcome
Twenty-eight patients (14F; 14M mean age 54.8±14.2 years) were enrolled; 42% were gene-positive, 27% had ICDs, and 7.6% had prior myomectomy. All commenced 5 mg daily per Australian guidance. Protocol-driven reviews generated 166 echocardiograms and consults in 25 months. Nurse-led reviews (39%) occurred at weeks 4 and 8, and one month after any dose increase. Stable patients alternated three-monthly between cardiologist and nurse reviews. Maintenance dosing was 2.5 mg (25%), 5 mg (50%), 10 mg (16.6%), and 15 mg (8.3%). Therapy ceased in two patients due to side effects; one required temporary interruption and dose reduction after EF fell below 50%. No scheduled appointments were missed.
Discussion/Conclusion
Mavacamten requires substantial clinical resources. A hybrid model can provide safe, effective, and sustainable care.