ÌÇÐÄvlog

In the 2011 American College of Cardiology Foundation and American Heart Association guidelines for the diagnosis and treatment of hypertrophic cardiomyopathy, explicit recommendations make clear that septal reduction therapy (whether surgical septal myectomy or transcatheter alcohol septal ablation) should be performed only by experienced surgeons in the context of a comprehensive hypertrophic cardiomyopathy clinical program for eligible patients with drug-refractory symptoms and left ventricular outflow tract obstruction.¹ This guideline statement was crafted after careful review of all available evidence and thoughtful deliberation among a group of experienced colleagues; it has merit. The national data presented by Kim et al² and highlighted in the commentary by Ommen and Nishimura³ in this issue of JAMA Cardiology point out the gulf between clinical practice guidelines and practice. Procedural volumes are low in most US hospitals performing these procedures, and in-hospital mortality is significantly higher when patients undergo either surgical myectomy or alcohol ablation at low-volume institutions.

Whereas adherence to guidelines when appropriate enables best patient outcomes, deviation from guidelines may result in important problematic consequences. The data presented by Kim et al² provide confirmatory evidence, once more, that this is the case. Continuous quality improvement necessitates that we remain vigilant in our application of cardiovascular care, transparent in our metrics of quality, and aligned with best practices.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.