AUTHOR=Witteles Ronald M. , Chung Haechung , Dai Feng , Gutierrez Cynthia , Rava Andrew , Swarup Sameer , Ebrahim Abbas , Pankratova Cindi 

TITLE=Trends in diagnostic testing in Medicare patients with wild-type transthyretin amyloid cardiomyopathy

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1638380

DOI=10.3389/fcvm.2025.1638380

ISSN=2297-055X

ABSTRACT=BackgroundMost patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) are diagnosed noninvasively, using nuclear imaging and monoclonal protein testing. However, concerns have been raised that some may receive an ATTRwt-CM diagnosis based on incomplete evaluations (not based on current consensus recommendations). Using a cohort of US Medicare Fee-for-Service patients, we aimed to examine the frequency and cadence of diagnostic testing for ATTRwt-CM.MethodsIn this retrospective observational cross-sectional study, administrative de-identified claims data from 2018 to 2022 were derived from patients aged ≥65 years who had at least one claim for ATTRwt-CM and heart failure or cardiomyopathy, and ≥2 years of continuous Medicare enrollment before the first ATTRwt-CM diagnosis. Patients with claims for any other form of amyloidosis, multiple myeloma, or plasma cell dyscrasias were excluded.ResultsAmong 2,050 patients with ATTRwt-CM, mean (SD) age was 80.0 (6.9) years, and 75.5% were men. Annual new ATTRwt-CM diagnoses nearly tripled over the study period (2018, n = 198; 2022, n = 578). Technetium-99m pyrophosphate (PYP) scintigraphy use was performed in approximately half of diagnosed patients by the end of the study period (2018, 30%; 2022, 49%). Cardiac biopsy use declined from 14% in patients diagnosed in 2018 to 5% in those diagnosed in 2022. A small minority (14%) of patients underwent the recommended noninvasive diagnostic testing comprised of PYP scintigraphy and complete monoclonal protein testing.ConclusionsBased on Medicare claims data, most patients diagnosed with ATTRwt-CM have not been diagnosed following consensus-recommended pathways.