OBJECTIVES: Hypertrophic cardiomyopathy (HCM) is a chronic, and often genetic, condition characterised by unexplained left ventricular hypertrophy often impacting patients’ quality of life. This retrospective study aims to analyse time to diagnosis (TTD) from referral and its association with time to adverse clinical outcomes post-diagnosis.

METHODS: Adult patients diagnosed with HCM between 2008 and 2022, with complete electronic patient notes/records that attended University Hospitals Coventry and Warwickshire (UHCW) were included. The index date was the ‘trigger event’, defined as the date in which clinicians agreed triggered the referral pathway to diagnosis.

RESULTS: Of 167 patients meeting study inclusion criteria, 128 had a clinically agreed trigger event. Of these, 62.5% were male, 79.7% were white, and the mean (standard deviation) age at diagnosis was 56.8 (15.4) years. Median TTD was 2.62 (interquartile range: 0.10-26.37) months. The majority (58.6%) of patients were non-obstructive. When stratifying by median TTD, patients greater than median (vs lower) were more likely to be diagnosed as an outpatient (92.1% vs 44.4%; p<0.001) and referred based on a cardiovascular trigger event (93.8% vs 76.6%) such as chest pain. 34.4% (vs 18.8%; p=0.045) of patients presented with pre-syncope and 31.3% (vs 15.6% p=0.037) presented with palpitations. Conversely, patients with a lower than median TTD were more likely to be diagnosed incidentally (17.2% vs 4.7%) and accounted for all observed out of hospital cardiac arrests (9.4% vs 0.0%; p=0.028). Patients with greater than median TTD (vs lower) observed shorter times between diagnosis and adverse clinical outcomes; with a Cox regression model derived hazard ratio of 1.52 (p=0.097) and 2.44 (p=0.050) for a composite of hospitalisation and death as well as age-adjusted death respectively.

CONCLUSIONS: This retrospective study highlights a clear differentiation of patient profiles when stratifying by TTD, with longer TTD associated with shorter time from diagnosis to age-adjusted mortality.