From the Guidelines
A patient with hypertrophic obstructive cardiomyopathy (HOCM) can be discharged from a cardiac ward when their acute episode has resolved, congestion is absent, and a stable oral diuretic regimen has been established for at least 48 hours, along with optimized long-term disease-modifying therapy, including a beta-blocker, as recommended by the European Society of Cardiology guidelines 1.
Discharge Criteria
To determine readiness for discharge, several key factors must be considered:
- Resolution of acute symptoms such as chest pain or dyspnea
- Heart rate and blood pressure within acceptable ranges
- Successful initiation of appropriate medications, such as beta-blockers, to reduce heart rate, contractility, and outflow obstruction
- Ability to perform basic activities without significant symptoms
- Understanding of the medication regimen, including potential side effects
Pre-Discharge Management
Before discharge, it is crucial to ensure that:
- The patient has a clear follow-up plan with a cardiologist within 1-2 weeks
- The patient understands warning signs requiring medical attention, such as worsening shortness of breath, chest pain, syncope, or palpitations
- The patient receives education about activity restrictions, including avoidance of strenuous exercise and adequate hydration, as outlined in the standards of care by the Heart Failure Association 1
Decision for Discharge
The decision to discharge a patient with HOCM from a cardiac ward should be based on the achievement of the primary goals of hospitalization: stabilization, initiation of therapy, and patient education. When these conditions are met, and the patient is hemodynamically stable with no complications requiring ongoing inpatient care, discharge to the outpatient setting is appropriate, allowing for continued management and follow-up with a cardiologist.
From the Research
Discharge Criteria for Hypertrophic Obstructive Cardiomyopathy Patients
The decision to discharge a patient with hypertrophic obstructive cardiomyopathy (HOCM) from a cardiac ward depends on several factors, including the patient's symptoms, left ventricular outflow tract (LVOT) obstruction, and response to treatment.
- Patients who are asymptomatic or have mild symptoms and no significant LVOT obstruction may be discharged with ongoing medical management, which may include β-blockers or verapamil 2, 3.
- Patients with persistent symptoms despite initial pharmacological therapy with β-blockade or verapamil may require further treatment, such as disopyramide, to relieve obstruction and improve symptoms 4.
- Patients who undergo septal reduction therapy, such as myectomy or alcohol septal ablation, may be discharged when they are clinically stable and have shown significant improvement in symptoms and reduction in LVOT gradient 5, 6.
Key Considerations for Discharge
- The patient's functional status and ability to perform daily activities should be assessed before discharge.
- The patient should be educated on the importance of ongoing medical management, lifestyle modifications, and follow-up appointments to monitor their condition.
- Patients with an increased risk of sudden cardiac death should be considered for cardioverter-defibrillator implantation before discharge 5.
- Patients with severe symptoms related to ventricular obstruction should be considered for septal reduction therapy before discharge 5, 6.