Expert Consensus and Clinical Pathway Recommendations for Transthyretin Amyloid Cardiomyopathy in Malaysia

Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive, life-threatening condition that remains under-recognised in Malaysia. Although disease-modifying therapies are available, their high cost and limited accessibility contribute to delays in diagnosis, compounded by gaps in clinical awareness, differences in diagnostic tool availability and disparities in healthcare resources. While international guidelines offer a comprehensive framework for diagnosing and managing ATTR-CM, local adaptation is essential to ensure their relevance and feasibility within the Malaysian healthcare system. This expert consensus provides practical, locally relevant recommendations to assist Malaysian clinicians in the timely identification and management of ATTR-CM. A multidisciplinary panel of clinicians from cardiology, haematology, nuclear medicine and other related specialties convened to develop tailored recommendations for national practice, drawing on international guidance, current evidence and local clinical practices. The guidance outlines key clinical features to raise early suspicion, proposes a diagnostic algorithm adaptable to different levels of care and offers recommendations on appropriate use of diagnostic tests-including imaging, laboratory investigations, tissue biopsy, and genetic testing when indicated-while emphasising the distinction between ATTR-CM and amyloid light chain amyloidosis, optimising non-invasive diagnostic approaches and fostering multidisciplinary collaboration across the care continuum. These consensus recommendations aim to enhance diagnostic accuracy, reduce variability in clinical practice and support earlier identification of ATTR-CM. By bridging global standards with local healthcare practices, this guidance equips clinicians to deliver timely, effective care for an underdiagnosed and often overlooked condition.