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, as well as optimization of long-term disease-modifying therapy, including a beta-blocker, as recommended by the European Society of Cardiology guidelines 1. When considering discharge, several key factors must be taken into account to ensure the patient's safety and optimal management of their condition. These include:
- Resolution of acute symptoms such as chest pain or dyspnea
- Stable vital signs with no arrhythmias on telemetry for a specified period, typically 24-48 hours
- Optimization of medical therapy, which may include beta-blockers to reduce heart rate, contractility, and outflow obstruction
- A clear follow-up plan, including an appointment with their cardiologist and arrangements for any needed cardiac rehabilitation
- Patient education on their condition, recognition of symptoms of worsening disease, and knowledge of when to seek emergency care, as emphasized in the guidelines for the diagnosis and treatment of acute and chronic heart failure 1. The decision to discharge should be based on the individual's clinical status rather than a fixed timeframe, prioritizing symptom control and prevention of sudden cardiac death through appropriate medical therapy and risk stratification. Key aspects of discharge planning involve:
- Ensuring the patient is on an optimized medical regimen
- Providing education on activity restrictions, medication adherence, and warning signs of disease worsening
- Arranging follow-up care to monitor the patient's condition and adjust treatment as necessary, in line with the standards of care laid out by the Heart Failure Association, as referenced in the guidelines 1.
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 should be based on individualized assessment of their functional status, symptoms, and response to treatment 2, 3.
- Patients who have achieved significant improvements in heart failure symptoms and a reduction in left ventricular outflow tract (LVOT) obstruction with medical management, such as β-blockers or verapamil, may be considered for discharge 4, 5.
- Those who have undergone septal reduction therapy, such as myectomy or alcohol septal ablation, and have shown improvement in symptoms and LVOT gradient, may also be discharged 6, 3.
- However, patients with persistent symptoms, significant LVOT obstruction, or high risk of sudden cardiac death may require ongoing monitoring and treatment in a cardiac ward 2, 6.
- The presence of comorbidities, such as atrial fibrillation, or the need for cardioverter-defibrillator implantation, may also influence the decision to discharge a patient with HOCM 6, 3.
Key Considerations for Discharge
- Patients should be asymptomatic or have minimal symptoms at rest and with exertion 4, 5.
- LVOT obstruction should be significantly reduced or absent 2, 3.
- Patients should be stable on their current medication regimen and have no signs of heart failure or arrhythmias 4, 5.
- A clear plan for follow-up and ongoing management should be in place before discharge 2, 3.