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Global Burden of Cardiac Amyloidosis in Heart Failure: A Systematic Review and Meta-Analysis

Syed Bukhari1, Mohammad Hamza, Muhammad Abdul Rehman

  • 1Johns Hopkins University.

Research Square
|February 6, 2026
PubMed

Insights

Cardiac amyloidosis (CA) affects 10% of heart failure (HF) patients globally, predominantly wild-type transthyretin amyloidosis (ATTRwt-CA). Underdiagnosis may occur in certain regions and among females, necessitating further research.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Medical Diagnostics

Background:

  • Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy increasingly recognized as a cause of heart failure (HF).
  • Accurate global prevalence data for CA is lacking, hindering effective management and screening strategies.
  • Advances in noninvasive diagnostics have improved CA detection rates.

Purpose of the Study:

  • To systematically review and meta-analyze existing studies to determine the global prevalence of CA in heart failure populations.
  • To investigate geographic, subtype, sex-based, and study design-related variations in CA prevalence.
  • To identify the predominant subtype of CA and assess its prevalence within screened populations.

Main Methods:

  • Systematic review and meta-analysis of studies identified through comprehensive database searches (PubMed Central, Cochrane, EMBASE, Web of Science).
  • Inclusion of 28 studies with 7,393 heart failure patients, diagnosed via technetium-labeled bone scintigraphy or biopsy.
  • Random-effects proportional meta-analysis to pool prevalence data and assess heterogeneity.

Main Results:

  • The pooled prevalence of CA among heart failure patients was 10% (95% CI, 7%-13%), with significant heterogeneity observed (prediction interval, 2%-41%).
  • Wild-type transthyretin amyloidosis (ATTRwt-CA) was the predominant subtype, accounting for 76% of CA diagnoses.
  • Prevalence varied geographically (6% in North America to 15% in Asia), and 24% of CA cases occurred in females, suggesting potential underdiagnosis.

Conclusions:

  • Cardiac amyloidosis is present in approximately one in ten heart failure patients worldwide, with ATTRwt-CA being the most common form.
  • Geographic variations and a notable proportion of cases in females suggest potential underdiagnosis in underrepresented regions and populations.
  • Standardized, multinational studies are crucial for a precise global burden assessment and to inform equitable screening strategies for CA.

Keywords:
Cardiac amyloidosisgender disparitiesglobal burdenheart failuretransthyretin amyloidosis

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