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Evaluation of the cardiac amyloidosis clinical pathway implementation: a real-world experience

Maaike Brons1, Steven A Muller1, Frans H Rutten2

  • 1Department of Cardiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.

European Heart Journal Open
|August 3, 2022
PubMed

Insights

Implementing a cardiac amyloidosis (CA) clinical pathway improved cardiologist awareness and reduced diagnostic delays and disease severity. This pathway enhances early detection and management of CA.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Clinical Pathways

Background:

  • Cardiac amyloidosis (CA) diagnosis is often delayed, leading to advanced disease at presentation.
  • Clinical pathways aim to standardize care and improve diagnostic efficiency.

Purpose of the Study:

  • To evaluate the impact of a cardiac amyloidosis (CA) clinical pathway on referring cardiologist awareness.
  • To assess changes in diagnostic delay and disease severity at diagnosis post-implementation.

Main Methods:

  • Retrospective study comparing 113 CA patients before (2007-18) and after (2019-20) CA clinical pathway implementation.
  • Analysis of electronic health records for patient demographics, referral reasons, diagnostic delay, and disease stage.

Main Results:

  • Increased cardiologist awareness of CA, evidenced by more referrals for unexplained heart failure and right ventricular hypertrophy.
  • Significant reduction in diagnostic delay from 14 to 8 months (P < 0.01).
  • Decreased presentation with advanced disease severity (NYHA Class III and Mayo/Gillmore Stage III/IV).

Conclusions:

  • The CA clinical pathway implementation successfully improved referring cardiologist awareness.
  • The pathway led to a significant decrease in diagnostic delay and disease severity at diagnosis.
  • Further research is needed to determine the long-term prognostic impact of this clinical pathway.
Abstract

Keywords:
Cardiac amyloidosisClinical pathwayLight chain amyloidTransthyretin

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