Gordon Fox • April 25, 2025
Decisions in HCM: Why are they so hard?

by Gordon Fox: 2nd in a series

Making decisions can be hard, and this is especially true when health is involved. A key reason is that most decisions involve more than one risk. 

Decisions involve multiple risks

For medical treatments, there is usually a risk of not treating, as well as a risk of treating. In other words, there are typically tradeoffs to evaluate. Imagine that your doctor has recommended you have an ICD implanted because you have a high risk of dangerous arrhythmias that might lead to cardiac arrest. Occasionally, we hear suggestions that all HCM patients should have ICDs, but that ignores the tradeoff: the treatment itself has the potential to cause problems from anesthesia, surgery, infection, inappropriate shocks, and defects in the devices and leads. And it costs money. Deciding to have an ICD implanted should be based on weighing the tradeoffs.

Some risks are known

We know a lot about how serious these risks are, so it's possible to say that (your actual risks will be different from these examples) "your risk of cardiac arrest is about 3% a year, and in about 5% of patients, the leads need to be repaired later.” 

Some risks can’t be calculated

Some issues have too many unknowns for anyone to calculate the risks. Perhaps you are deciding whether to have a child. If you have a gene mutation that promotes HCM, we know exactly what the chance is that your child will also have that mutation. But we can't say what the chance is that they will develop HCM because we still need to understand more about the process that causes some people to develop the disease while others don't. 


Some risks could not be measured even if all the scientific issues were worked out. In deciding whether to have a child, there are issues like how you will feel if your child has HCM. That is a real issue that should enter into decision-making, but nobody can say whether you will feel OK about it.


Aims of this blog series

In this series of blog posts, we will consider some examples of complex decisions that HCM patients often have to make. We can't tell you the best choice- sometimes that depends on your values. We hope you will gain some insights into thinking about all the risks and benefits and how to use that information to make rational decisions.




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HCMA Blog

Hypertrophic Obsctructive Cardiomyopathy
By Erica Friedman April 22, 2025
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April 15, 2025
It is hard to believe the first quarter of 2025 is in the history books. In the space of hypertrophic cardiomyopathy and thick heart muscle disorders, the distance between the promise and the delivery of a reality freed from burden of disease is closer than it has ever been, not only in the United States but throughout the world. Unfortunately, we are navigating through some challenging health policy times, which will impact a large percentage of those with the diseases we seek to serve. While we navigate these challenging waters together, we remain committed to ensuring safe, accessible, affordable healthcare while ensuring the rights of those with disabilities are maintained. Last month, I attended two large conferences - one held in Stockholm, Sweden the other Chicago, Illinois. The research communities worldwide are holding their breath, waiting to see how we will move forward, even as we continue to develop new therapies, treatments and, even potentially, cures. It has never been more important to keep research moving, as we are so close to so many amazing improvements in our ability to care for those with thick heart muscle disorders, including HCM in all its forms, Amyloidosis, Fabry’s disease, Danon disease, and RASopathies. There was amazing science presented at the American College of Cardiology, where we warmly welcomed new president, Dr. Christopher Kramer, the original director of the hypertrophic cardiomyopathy center at University of Virginia. We look forward to his leadership and wish him well in his challenging tasks ahead. Later this month we will be in Orlando, Florida - please register and join us for this wonderful Bighearted warrior tour in person with our friends at AdventHealth and the incomparable Dr. Marcos Hazday. I even understand that there's some carpooling being organized from the Tampa area. If you're interested, reach out to the office and we will connect you. Maybe, the most impactful thing that will happen in the month of April is that we will conduct our second visit to Capitol Hill. Our lead topic this year is something you have heard us talk about at many prior meetings of the HCMA and podcasts; the generic drug quality issue. We are proud to be partnering with David Light, Co-founder and President of Valisure, and retired Colonel Vic Suarez, to ask House and Senate members to support the inspection of all generic drugs purchased by the Department of Defense and the Veterans Administration and make results of these inspections open for public use. Secondly, we are seeking rational oversight of health insurance companies’ abuse of prior authorizations and step therapy requirements. These issues cost an estimated 1.3 billion dollars a year and provide nothing to keep a patient safer or a physician's office running more efficiently. Common sense tells us to not waste money where there is no return. Additionally, prior authorizations and step therapies can keep patients sicker longer, ultimately costing the healthcare system more money. Our briefing will educate Representatives to act in an informed manner when moving policies that impact us all. You can watch the video of our briefing from Wednesday, April 9th on Vimeo: https://vimeo.com/event/5043266 If you wish to get involved or more informed on any of the issues above, I encourage you to visit the website, 4hcm.org , or reach out to the office and the staff will be happy to assist you. On the day before I head out to Washington DC, I will leave you with this one thought - we have come a really long way in our understanding of HCM over the past 60 years. We have increased the lifespan of those with HCM, through collaborative research and implementation of best practices in an organized fashion throughout this country. We have worked so hard to end suffering for so many, and we are succeeding in our shared goal to outsmart hypertrophic cardiomyopathy and other thick heart muscle disorders. It is important to continue the research into all aspects of these diseases, including the biological, the clinical, and burden of disease measurements. System improvements, positive impact of timely diagnosis and treatment, and the value to society of all of these big hearts being here, will help keep their families whole. So we're off to DC to try to educate others about what it really means to live in our ecosystem. Best wishes, Lisa
Three colored chevrons create a decision flowchart: Identification, Analysis, Evaluation.
By Gordon Fox April 14, 2025
This first in a series post about making decisions as you navigate living with HCM, focuses on the three steps of decision-making: Identification, Analysis, Evaluation.
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