Addressing discrepancies in symptom and psychosocial assessments in hypertrophic cardiomyopathy

Abstract

This correspondence critiques a 2025 study by Tsenov et al. on hypertrophic cardiomyopathy, highlighting discrepancies in reported symptom burden, psychological support, employment impact, diagnostic delays, activity restrictions, and medication tolerability. Recent evidence suggests improved outcomes with novel therapies and integrated care, challenging the study's conclusions. We advocate for reconciled analyses and future longitudinal studies to enhance patient-centered hypertrophic cardiomyopathy management.

Dear Editor,

We read with interest the article by Tsenov et al. (2025) on healthcare access, symptom burden, and psychological impact in hypertrophic cardiomyopathy (HCM), published in the International Journal of Cardiology Cardiovascular Risk and Prevention [1]. The authors offer important patient-driven insights into the lived experiences of HCM across Europe, emphasizing gaps in management and care. However, we aim to critique several conclusive findings, as they exhibit inconsistencies with recent evidence, which may influence their implications for clinical practice.

First, the assertion of persistent symptom burden despite treatment overlooks the efficacy of emerging therapies in alleviating symptoms. While the study reports ongoing high impact from shortness of breath and fatigue, clinical trials demonstrate significant reductions in these symptoms with cardiac myosin inhibitors [2], suggesting that access to newer agents could mitigate burden more effectively than implied.

Second, the conclusion that psychological support is markedly limited (only 15 % consulting psychologists) undervalues integrated care models in specialized centers, where routine psychological assessments are associated with higher utilization rates and improved outcomes. Recent analyses indicate that structured interventions address anxiety and depression more comprehensively [3], contradicting the portrayed unmet needs.

Third, the reported significant employment impact (15 % job loss, 14 % reduced hours) conflicts with evidence from large cohorts showing that, while productivity losses exist, outright job loss is less prevalent under modern management, potentially due to better symptom control and accommodations [4]. This discrepancy may overstate socioeconomic burdens in well-managed patients.

Fourth, the emphasis on diagnostic delays and misdiagnoses (29 %) as indicative of critical gaps is challenged by recent data from European registries, which report improved accuracy and shorter delays attributable to enhanced genetic testing and awareness campaigns [5]. This suggests diagnostic pathways have evolved, reducing the systemic issues highlighted.

Fifth, the pronounced reduction in physical activity post-diagnosis (63 %) and shift to low-moderate levels contradicts guideline-endorsed approaches promoting tailored exercise [6], which have been shown to enhance quality of life without elevating risks in stable HCM patients.

Sixth, the perceived high burden of side effects from traditional medications like beta-blockers is not aligned with the favorable tolerability profiles of novel myosin inhibitors [7], which exhibit mild, transient adverse events and fewer disruptions to quality of life.

In summary, these inconsistencies regarding symptom persistence, psychological support, employment effects, diagnostic efficiency, activity restrictions, and medication tolerability weaken the study's conclusions on HCM management gaps. We encourage the authors to reconcile these with contemporary data, possibly via subgroup re-analyses. Future studies should incorporate longitudinal assessments and novel therapies to better inform patient-centered strategies.

CRediT authorship contribution statement

Brijesh Sathian: Conceptualization, Supervision, Writing – original draft, Writing – review & editing. Abdalla Fadul: Conceptualization, Investigation, Writing – review & editing. Yasir Alabbas: Investigation, Writing – original draft, Writing – review & editing. Hanadi Al Hamad: Conceptualization, Investigation, Writing – review & editing.

Data availability statement

Data sharing not applicable – no new data generated, or the article describes entirely theoretical research.

Ethics approval statement

As this is a commentary on a published study and no new data were collected or analyzed, ethics approval was not required.

Funding statement

No funding was received for the preparation or submission of this letter.

Declaration of competing interest

The authors declare no conflicts of interest related to this letter.

Handling editor: D Levy