Implementing Cardiac Myosin Inhibitors in oHCM: Workflow and Team-Based Care

Effective implementation of cardiac myosin inhibitor therapy for oHCM depends heavily on systems of care rather than on the prescribing physician alone. Mariko Harper, MD, describes a dedicated cardiac myosin inhibitor clinic in Washington State staffed by a cardiac pharmacist who functions in many ways like an advanced practice provider. This pharmacist leads initiation, titration, drug–drug interaction review, and REMS documentation, while nurse coordinators manage direct lines of communication, scheduling, and coordination of echocardiography. Advance scheduling of the first several echocardiograms at the time of therapy planning, with flexibility to adjust as needed, provides clarity for patients and staff.

Matthew Martinez, MD, highlights the role of telemedicine for interim visits, which allows efficient, geographically flexible follow-up and facilitates rapid response to clinical or imaging changes. He and Harper emphasize that experienced sonographers, nurses, advanced practice providers, and pharmacists must function as equal partners in a “team sport,” with explicit empowerment to escalate concerns such as suspected atrial fibrillation or unexpected gradient patterns. Over time, as volumes increase, team members train newer staff, transforming what initially feels like a challenging REMS-driven process into a predictable, streamlined workflow after the first several patients.

Martinez and Harper also offer granular practical advice, such as coordinating the actual start date of therapy with the timing of follow-up echocardiography and patient support. They encourage patients to contact the nurse coordinator as soon as the initial shipment is received so that day 1 dosing and subsequent imaging timelines can be aligned. Martinez often recommends initiating therapy on a Sunday evening to maximize weekday availability for early follow-up and to ensure that questions about tolerability arise during regular clinic hours. This segment provides a detailed operational blueprint for clinicians seeking to integrate cardiac myosin inhibitors into everyday oHCM practice while maintaining high safety and patient satisfaction standards.