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Sudden death predictor identifies ICD candidates in new ESC Guidelines

Myocardial Disease

Barcelona, Spain – Saturday 30 August 2014: A new sudden death predictor for patients with hypertrophic cardiomyopathy (HCM) identifies candidates for implantable cardioverter defibrillators (ICDs) in ESC Guidelines published today. They are presented at ESC Congress by Task Force Chairperson Professor Perry Elliott (UK).
The “2014 ESC Guidelines on Diagnosis and Management of Hypertrophic Cardiomyopathy” are published today on-line in the European Heart Journal (1) and on the ESC Website. Previous ESC Guidelines on hypertrophic cardiomyopathy were published in 2003 (2).

Professor Elliott said: “One of the most important innovations in this guideline is a new risk calculator that uses simple clinical measures to estimate five year risk of sudden cardiac death. This estimate is then used to stratify patients into high, intermediate and low risk categories that can be used to guide the use of ICDs.”

He added: “These recommendations are likely to spark considerable interest and debate as they provide advice based on real estimates of risk rather than relative risks as in all previous guidelines. This will bring into focus the balance between clinical efficacy on the one hand and on the other, the potential risks and costs of therapy to individual patients and healthcare economies.”
Professor Elliott continued: “In some aspects of the guidelines we had to balance an ideal of best practice with the realities of healthcare provision across Europe and elsewhere. Nevertheless, we make a number of recommendations that will prove challenging in some countries with the deliberate aim of raising the general standard of care for all patients.”
Examples include a recommendation for genetic testing in all patients with HCM when it is of relevance to the management of family members; greater use of specialised tests such as cardiac magnetic resonance imaging in everyday practice; and early referral to multidisciplinary teams with expertise in the diagnosis and management of HCM.
Most cases of HCM have a genetic cause and the guidelines provide a clinically focused approach to the requesting and interpretation of genetic tests. This is based on careful history taking including analysis of family pedigrees and a cardiomyopathy-centred interpretation of commonly used diagnostic tools such as electrocardiography and cardiac imaging.

Professor Elliott said: “The aim is to improve the accuracy of diagnosis and the management of patients and families with HCM. The role of expert counselling before and after genetic analysis is strongly emphasised and we provide clear guidance on the management of family members in different clinical scenarios based on the results of genetic testing.”

Detailed and tailored advice is provided for women with HCM. This includes guidance on pre-pregnancy assessment and the management of labour, and detailed recommendations for contraception, sterilisation and termination. Advice on the diagnosis and treatment of children is provided for the first time.
Left ventricular outflow tract obstruction is a common feature of HCM that can be treated with drugs or invasive therapies such as surgery and alcohol septal ablation. For the first time, the guidelines present a systematic approach to the assessment of outflow tract obstruction that can be used to tailor therapies to the characteristics of individual patients. A simple guide is also provided for drug and device therapy in patients with HCM and heart failure.

Professor Elliott concluded: “We hope that these guidelines will enable healthcare professionals to raise the standard of care for patients of all ages with HCM by improving the accuracy of diagnosis and the use of a rational, patient centred approach to advice and clinical management.”

Watch Prof Elliot's interview


(1) 2014 ESC Guidelines on Diagnosis and Management of Hypertrophic Cardiomyopathy. European Heart Journal. 2014 doi:10.1093/eurheartj/ehu284
(2) American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines. European Heart Journal. 2003;24(21):1965-1991.
Guidelines at ESC Congress - The Hypertrophic Cardiomyopathy Guidelines will be featured in:
•    A dedicated session on Monday 1 September at 08:30
•    A ‘Meet the Guidelines Task Force’ session on Monday 1 September at 15:40
•    An ESC Guidelines 2014 overview session on Sunday 31 August at 11:00
•    An article in Congress News on Monday 1 September.

Notes to editor

The ESC Pocket Guidelines will be distributed in Barcelona in their paper version and the ESC Pocket Guidelines Application will be available to download for free from the Apple Store and Google Play.
The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies.
It is the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 80 000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.
About ESC Congress 2014
The ESC Congress is currently the world's largest international congress in cardiovascular medicine.  The spotlight of this year's event is “innovation and the heart”.  ESC Congress 2014 takes place from 30 August to 3 September at the Fira Gran Via in Barcelona, Spain. For more information on ESC Congress 2014 contact the ESC Press Office.
To access all the scientific resources from the sessions during the congress, visit ESC Congress 365
About the ESC Clinical Practice Guidelines
ESC Guidelines aim to present all the relevant evidence on a particular clinical issue in order to help physicians to weigh the benefits and risks of a particular diagnostic or therapeutic procedure. They should be helpful in everyday clinical medical decision-making.
About the European Heart Journal (EHJ)
The European Heart Journal is the flagship journal of the European Society of Cardiology. It is published on behalf of the ESC by Oxford Journals, a division of Oxford University Press. Please acknowledge the journal as a source in any articles.
This press release accompanies a presentation at the ESC Congress 2014. Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter.