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Impact of a Checklist-Based Strategy for Cardiac Amyloidosis Screening on Diagnosis Rates in Heart Failure Patients

Alberto Pérez-Nieva1, Pau Llàcer1, Prado Salamanca-Bautista2

  • 1Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Department of Medicine and Medical Specialties, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, Madrid, Spain.

European Journal of Internal Medicine
|August 22, 2025
PubMed

Insights

Implementing a checklist for transthyretin-associated cardiac amyloidosis (ATTR-CM) in heart failure (HF) units increased diagnosis rates tenfold. A low QRS-to-mass ratio was the strongest predictor of ATTR-CM in elderly patients.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Public Health

Background:

  • Transthyretin-associated cardiac amyloidosis (ATTR-CM) is an underdiagnosed cause of heart failure (HF), especially in older adults.
  • Delayed diagnosis of ATTR-CM hinders access to effective disease-modifying treatments.
  • Early detection is crucial for improving patient outcomes in ATTR-CM.

Purpose of the Study:

  • To assess the impact of a checklist-based screening strategy for ATTR-CM in specialized heart failure (HF) units.
  • To evaluate the feasibility and effectiveness of implementing a structured diagnostic workup for ATTR-CM.
  • To identify key predictors of ATTR-CM in elderly HF patients.

Main Methods:

  • A prospective, multicenter, observational study involving elderly patients (≥65 years) with HF and positive screening checklists.
  • Comparison with a retrospective control cohort from the same centers to determine ATTR-CM diagnosis rates.
  • Structured diagnostic workup for ATTR-CM, including identification of independent predictors and 6-month clinical outcomes.

Main Results:

  • The prospective cohort showed a significantly higher ATTR-CM diagnosis rate (21.6%) compared to the retrospective cohort (1.8%).
  • A low QRS-to-mass ratio was the strongest independent predictor of ATTR-CM (OR 41.02), followed by septal thickness, age, LV mass index, and BMI.
  • Clinical outcomes at 6 months were comparable between patients with and without ATTR-CM.

Conclusions:

  • A checklist-based screening strategy effectively increased ATTR-CM detection tenfold in elderly HF patients.
  • Low QRS-to-mass ratio is a key indicator for ATTR-CM, aiding early diagnosis.
  • Checklist implementation is a feasible approach to improve the early identification of underrecognized ATTR-CM.
Abstract

Keywords:
ATTR-CMCardiac amyloidosisChecklistDiagnosisElderlyHeart failureScreening

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