Update on hypertrophic cardiomyopathy and a guide to the guidelines

Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disorder, affecting 1 in 500 individuals worldwide. Existing epidemiological studies might have underestimated the prevalence of HCM, however, owing to limited inclusion of individuals with early, incomplete phenotypic expression. Clinical manifestations of HCM include diastolic dysfunction, left ventricular outflow tract obstruction, ischaemia, atrial fibrillation, abnormal vascular responses and, in 5% of patients, progression to a 'burnt-out' phase characterized by systolic impairment. Disease-related mortality is most often attributable to sudden cardiac death, heart failure, and embolic stroke. The majority of individuals with HCM, however, have normal or near-normal life expectancy, owing in part to contemporary management strategies including family screening, risk stratification, thromboembolic prophylaxis, and implantation of cardioverter-defibrillators. The clinical guidelines for HCM issued by the ACC Foundation/AHA and the ESC facilitate evaluation and management of the disease. In this Review, we aim to assist clinicians in navigating the guidelines by highlighting important updates, current gaps in knowledge, differences in the recommendations, and challenges in implementing them, including aids and pitfalls in clinical and pathological evaluation. We also discuss the advances in genetics, imaging, and molecular research that will underpin future developments in diagnosis and therapy for HCM

Frailty in advanced heart failure: a systematic review

© 2015, Springer Science+Business Media New York. Frailty is a common geriatric syndrome of increased vulnerability to adverse events. The prevalence of frailty among chronic heart failure (CHF) is high and confers a greater risk of adverse events including falls, hospitalisation and mortality. There have been few studies assessing frailty in CHF. A review of the key databases was conducted from 2004 to 2014 including the key search terms ‘frail elderly’ and ‘heart failure’. The following electronic databases were searched: Medline, Cumulative Index for Nursing and Allied Health and Academic Search Complete, with reference lists being manually searched. Articles were included if frailty was assessed using a valid measuring tool in a population with a confirmed diagnosis of CHF. The search yielded a total of 393 articles with 8 articles being selected for review. The prevalence of frailty among those with CHF was high, ranging from 18 to 54 %. The frailty phenotype and geriatric assessments tools were the most common frailty measures utilised; high rates of co-morbidity, hospitalisation and mortality were identified. Frailty is common in CHF and is associated with adverse outcomes