TOPLINE:

Most older adults with transthyretin cardiac amyloidosis (ATTR-CM) experienced at least 6 months of delay in diagnosis after a first heart failure (HF) diagnosis. Those delays did not improve over time. Women and patients with certain comorbidities were more likely to experience a delayed diagnosis.

METHODOLOGY:

• Researchers analyzed US Medicare fee-for-service claims from January 2016 to December 2022 to assess delays in diagnosing ATTR-CM after an HF diagnosis and to identify associated factors.
• They included beneficiaries aged 65 or older with a new HF or cardiomyopathy diagnosis and an amyloidosis diagnosis who had at least 3 years of continuous enrollment in Medicare Parts A-C and 6 months of Part D coverage.
• The final cohort included 7770 patients. The median age of the patients was 81 years, and 77% were men.
• The primary outcome was the number of days between the first HF diagnosis and the first ATTR‑CM diagnosis, with a delay defined as a gap of more than 6 months.

TAKEAWAY:

• The median time from HF diagnosis to ATTR-CM diagnosis was 494 days, and 64% of patients had 6 months or more of delay in diagnosis. The percentage did not improve from 2016 to 2022 despite an increase in the number of ATTR-CM diagnoses.
• Among 6175 patients who had been prescribed loop diuretics before ATTR-CM diagnosis, the median time from prescription to amyloidosis diagnosis was 840 days.
• Women had 28% increased odds of delayed diagnosis (P < .05). Patients with aortic stenosis, coronary artery disease, diabetes, hypertension, or chronic obstructive pulmonary disease had 18%-39% higher odds of delay (P < .05 for all).
• Each 10-year increase in age was associated with 32% lower odds of delayed diagnosis (P < .05). Atrial fibrillation and carpal tunnel syndrome were also associated with lower odds of delay (P < .05 for both).

IN PRACTICE:

“[The study] findings highlight the importance of conducting a comprehensive assessment of potential causes of cardiomyopathy when diagnosing HF and underscore the urgent need for new strategies to reduce the time to an accurate diagnosis of ATTR-CM,” the researchers of the study wrote.

SOURCE:

The study was led by Gabriela Spencer-Bonilla, MD, MSc, of Stanford University School of Medicine in Stanford, California. It was published online on April 29 in JAMA Cardiology.

LIMITATIONS:

The algorithm was restricted to patients with both an amyloidosis code and an HF or cardiomyopathy code, and its accuracy in other patients remained unclear. The study only included fee-for-service Medicare beneficiaries older than 65 and did not include younger patients or those in Medicare Advantage. Researchers could not confirm whether loop diuretics were used for other reasons or if HF diagnoses were delayed.

DISCLOSURES:

The study received funding from AstraZeneca, the American Heart Association, and the National Heart, Lung, and Blood Institute. Several authors received research support from the funding agencies. Three authors reported being employees of AstraZeneca, and some disclosed holding stocks in the company. Multiple authors reported receiving personal fees or consulting payments from or having other industry relationships with various pharmaceutical and biotechnology companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.