How can I effectively monitor the progression of dilated cardiomyopathy in my patients?

Effective monitoring of dilated cardiomyopathy (DCM) progression involves regular clinical assessment and investigations tailored to the severity and stability of the condition.

• Perform a clinical assessment at least every 6 months if the patient is stable, including evaluation of functional capacity using the New York Heart Association (NYHA) classification, fluid status (checking for oedema, raised jugular venous pressure, lung crepitations), cardiac rhythm (pulse rate and rhythm), cognitive and nutritional status, and review of symptoms such as palpitations, breathlessness, and syncope. More frequent reviews (days to 2 weeks) are needed if clinical condition or medication changes occur ¹.
• Monitor renal function (serum urea, electrolytes, estimated glomerular filtration rate) every 6 months, with more frequent monitoring if comorbidities or medication changes warrant it ¹.
• Review and optimize heart failure medications regularly, including ACE inhibitors, ARBs, beta-blockers, and mineralocorticoid receptor antagonists, with monitoring of blood pressure, renal function, and electrolytes before and after dose changes ².
• Consider measuring N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in patients under 75 years old with heart failure and preserved renal function to guide treatment optimization and monitor disease progression, especially if baseline NT-proBNP is elevated (>2114 pg/mL) ¹.
• Use ECG or 24-hour ECG monitoring to detect arrhythmias, particularly if syncope or presyncope occurs, as ventricular arrhythmias are common in DCM with reduced ejection fraction ¹.
• Provide patients with education and self-management plans, including advice on symptom monitoring and when to seek urgent care ¹.
• Refer patients with left ventricular ejection fraction ≤35% or those with valvular heart disease for specialist assessment, as they may be candidates for advanced therapies such as implantable cardioverter defibrillators or cardiac resynchronization therapy ¹.
• Offer supervised exercise-based cardiac rehabilitation programs when the condition is stable to improve functional capacity and quality of life ¹.