Increasing clinicians' suspicion of ATTR amyloidosis using a retrospective algorithm

Area of Science:

• Cardiology
• Medical Diagnostics
• Amyloidosis Research

Background:

• Transthyretin amyloidosis (ATTR) is often underdiagnosed in cardiology settings.
• Increasing the index of suspicion for ATTR is crucial for timely diagnosis and treatment.

Purpose of the Study:

• To implement and evaluate an algorithm designed to enhance ATTR suspicion among cardiologists.
• To assess the impact of the algorithm on screening rates and diagnostic yield for ATTR.

Main Methods:

• A retrospective algorithm was developed to identify patients at risk for ATTR.
• Cardiologists received patient lists and testing guidelines, influencing their decision to order further evaluation.
• Trends in Technetium 99m-Pyrophosphate (PYP) scan orders and ordering physicians were tracked before and after the intervention.

Main Results:

• PYP scan orders increased significantly post-intervention (from 22 to 142 over comparable periods).
• The number of ordering physicians rose from 7 to 22, indicating broader engagement.
• The rate of equivocal or positive PYP scan results also increased, suggesting improved detection.

Conclusions:

• The algorithm effectively lowered the threshold for ATTR testing among clinicians.
• The intervention successfully increased the number of cardiologists ordering appropriate ATTR screening.
• More positive ATTR diagnoses were achieved following the implementation of the algorithm.