The cardiac amyloidosis clinical pathway implementation: a real world experience

Abstract

Abstract Background/Introduction Prognosis for patients with cardiac amyloidosis (CA) is determined by disease stage at diagnosis, underlining the importance of timely referral. In 2018, a CA clinical pathway was implemented in an Amyloidosis Expert Center in The Netherlands to increase regional awareness. Purpose To evaluate the impact of CA clinical pathway implementation. Methods Patients diagnosed before implementation (2007–2018; T1) were retrospectively compared to the period after clinical pathway implementation (2019–2020; T2). Demographics and disease characteristics were collected from electronic health records. Results In total, 113 patients were diagnosed, mean age 67.8±8.5 years, 26% female. AL-CA was diagnosed in 62%, ATTR-CA in 38%. The number of CA diagnoses/year increased over time (Figure 1). NYHA class III (45% vs. 24%,p=0.04), CA stage (MAYO/Gillmore stage III or IV; 59% vs. 33%, p=0.03) and delay between symptoms and diagnosis (14.5 vs. 8.4 months, p<0.01) improved considerably between T1 and T2. Reasons for referral changed over time, with increasing awareness for right ventricular hypertrophy (9% vs. 36%) and unexplained HFpEF (22% vs 38%). Conclusion CA patients were diagnosed earlier with less severe symptoms. Clinical pathway implementation facilitated regional increased awareness and improved timely referral. Funding Acknowledgement Type of funding sources: None.