Mavacamten in Obstructive Hypertrophic Cardiomyopathy: National Insights on Access and Safety Profile From Real‐World Data

BACKGROUND: Mavacamten improves symptoms in obstructive hypertrophic cardiomyopathy, but real-world prescription patterns, safety profile, and the effect of atrial fibrillation (AF) on outcomes remain unclear. METHODS: An observational multicenter analysis using patient-level data from the TriNetX database (2011-2023) compared patients with obstructive hypertrophic cardiomyopathy treated with mavacamten versus those not treated with mavacamten (controls). Multivariable logistic regression identified predictors of mavacamten use. Propensity-score matching was used to reduce confounding bias. Outcomes included acute heart failure, left ventricular systolic dysfunction, cardiovascular hospitalization, new-onset AF, and all-cause mortality. Outcomes were also stratified by AF history. RESULTS: <0.01). Older age independently predicted acute heart failure, whereas baseline AF predicted both cardiovascular and all-cause hospitalization. CONCLUSIONS: Black patients have markedly lower access to mavacamten. Preexisting AF was associated with a higher risk of adverse outcomes for patients on mavacamten, highlighting the need for careful monitoring.