Mavacamten implementation into practice

Mid & South Essex NHS Foundation Trust

Project summary

Hypertrophic cardiomyopathy (HCM) is a common cardiac genetic disorder with a prevalence of 1 in 500. Essex with a population of 1.9 million, has an estimated 3,800 people living with HCM. Essex cohort some of the most deprived neighbourhoods; 2025 statistics rank areas in Jaywick and Clacton-on-Sea as the most deprived neighbourhood in England (1).

Studies have shown that people with HCM that live in an area of low income or worse social deprivation index are associated with adverse outcomes (2). Contributory factors include limited access to expert care, reduced medicine adherence and financial constraints to commit to ongoing appointments e.g. time off work, childcare and transportation.

Mavacamten is a first-in-class myosin inhibitor that targets the underlying pathophysiology of symptomatic obstructive HCM. This is a significant breakthrough because up until now the available pharmacological treatment has been used to control symptoms only. Mavacamten is prescribed by Inherited Cardiac Conditions (ICC) specialist centres. The Essex cardiothoracic centre is the only hospital in Essex that provide ICC services, which may pose a barrier for people from various geographic location in Essex to access our care.

Mavacamten treatment requires genomic testing and regular echocardiogram monitoring. It is primarily metabolised by CYP2C19, this confers a potential for extensive drug-drug interactions and warrant the need for a thorough drug history review together with patient counselling. We designed a clinical service that allows for multiple healthcare touch point per visit. Pre-screening, genetic blood test and high-cost drug proformas are completed prior to the initiation clinic. Patients are offered virtual follow up at maintenance phase.

Local outcomes show reduced biomarkers; hs-Troponin T & NT-proBNP, and improvement in symptoms. Later real-world data published from three hospitals, including the Essex cardiothoracic centre, show similar findings.

This paper describes the multidisciplinary (MDT) collaboration of a small team in expediting the access of mavacamten. In doing so, we overcame clinical and operational challenges and was the first 5 hospitals in the country to offer this treatment. The MDT have both jointly and separately given talks in various forums to share our experiences.

This project was delivered when mavacamten was introduced in September 2023. Since then, experienced has been gained and service models have evolved overtime for both our hospital and others.

(1)   English indices of deprivation 2025: statistical release https://www.gov.uk/government/statistics/english-indices-of-deprivation-2025/english-indices-of-deprivation-2025-statistical-release Updated Nov 2025.

Hafeez. N et al. Social Determinants of Health and Clinical Outcomes in Hypertrophic Cardiomyopathy. JAMA Cardiology. 2026;11(2):165-174.