Heart failure & cardiomyopathiesCohort study
Timeliness of Transthyretin Cardiac Amyloidosis Diagnosis in the Medicare Population
- Retrospective cohort study
- US Medicare fee-for-service data
Authors' conclusion
There were substantial delays between incident HF and diagnosis of ATTR-CM found in this study. Female sex and having a history of aortic stenosis, coronary artery disease, diabetes, hypertension, or chronic obstructive pulmonary disease, which are each associated with cardiomyopathy and breathlessness, were associated with delayed diagnosis.
Study context
- Population
- Medicare fee-for-service beneficiaries with heart failure (HF) and ATTR-CM, 2016–2022
- Participants
- 7,770 beneficiaries
- Outcome
- Time to ATTR-CM diagnosis (days from first HF diagnosis to first ATTR-CM diagnosis)
Main finding
As reported in the abstract
Median (IQR) time from HF diagnosis to ATTR-CM diagnosis
494 (63-1340) days
Observational data: associations, not effects.
Further findings
Time from initial loop diuretic prescription to ATTR-CM diagnosis (6175 patients with loop diuretic before ATTR-CM diagnosis)
- Median (IQR) time from initial loop prescription to ATTR-CM diagnosis
- 840 (252-1768) days
Factors associated with lower odds of delayed diagnosis (>6 months from HF to ATTR-CM diagnosis)
OR
- Older age
- 0.68 (95% CI 0.63-0.74)
- History of AF
- 0.39 (95% CI 0.33-0.49)
- Carpal tunnel syndrome
- 0.85 (95% CI 0.74-0.97)
- multivariable logistic regression, adjusted
Factors associated with higher odds of delayed diagnosis (>6 months from HF to ATTR-CM diagnosis)
OR
- Female sex
- 1.28 (95% CI 1.13-1.45)
- History of aortic stenosis
- 1.39 (95% CI 1.20-1.62)
- Chronic obstructive pulmonary disease
- 1.18 (95% CI 1.03-1.34)
- CAD
- 1.26 (95% CI 1.13-1.40)
- Diabetes
- 1.21 (95% CI 1.07-1.37)
- Hypertension
- 1.28 (95% CI 1.13-1.45)
- multivariable logistic regression, adjusted
Original publication
Summarised from the published abstract; every number is checked against it