Comprehensive oHCM Follow-up: Hub-and-Spoke Care and 4-Pillar Framework

As oHCM prevalence and recognition increase, the limited capacity of specialized centers necessitates collaborative care models. Mariko Harper, MD, advocates for a hub-and-spoke strategy in which HCM centers of excellence provide initial diagnosis, risk stratification, and treatment planning, then partner closely with community cardiologists who assume much of the ongoing imaging, rhythm monitoring, and general cardiovascular management. Virtual initial consultations allow for early education, efficient planning of on-site testing, and tailored delegation of which assessments should occur locally versus at the referral center. Patients typically value annual visits to the expert center for complex counseling, genetic and family screening updates, and information on emerging therapies and clinical trials.

Matthew Martinez, MD, introduces a four-pillar framework he uses to structure follow-up encounters. The first pillar is symptom assessment, with attention to new, progressive, or changing limitations, including patients who underreport symptoms because of uncertainty about next steps. The second pillar is arrhythmia surveillance, particularly atrial fibrillation and ventricular tachycardia, both for symptom control and sudden cardiac death risk stratification. The third pillar involves family-based care, focusing on genetic testing where appropriate, periodic imaging of first-degree relatives, and reassessment of family history as life circumstances evolve. The fourth pillar centers on lifestyle, encompassing exercise prescriptions, weight management, nutrition, and pregnancy planning when relevant.

Within this structure, Martinez and Harper discuss practical use of stress echocardiography to detect latent obstruction even in patients deemed nonobstructive for many years, as well as the growing role of natriuretic peptides such as NT-proBNP in flagging changes in hemodynamics or unveiling new processes such as diastolic dysfunction or concomitant amyloidosis. They describe MRI at 3- to 5-year intervals in many patients for fibrosis assessment and risk stratification, and yearly echocardiography in most individuals—more frequently when on titrated medical therapy. This segment illustrates how Martinez and Harper integrate advanced diagnostics, collaborative care, and structured clinical frameworks to deliver comprehensive, long-term management for patients and families affected by oHCM.