Lessons Learned From The Cardiac Amyloidosis Management Program: The Hartford Experience.

Cardiac amyloidosis (CA) is an increasingly recognized cause of heart failure especially in patients with preserved ejection fraction. Care in a dedicated center involving a multidisciplinary team improves the management and outcomes in CA. Such centers are still scarce, and access to patient care is still limited. To promote awareness of the disease, and help standardize the care of these complex patients while keeping care local we established a cardiac amyloidosis management program (CAMP) in early 2019. We describe our 5-year experience with the program. Our CAMP was established in March 2019 in a tertiary care university affiliate teaching hospital system. Herein, we review the growth in awareness, referral patterns, and clinical outcomes from March 2019 to March 2024. We formed a multidisciplinary team including members from heart failure, imaging, hematology/oncology, neurology, and pathology. Since the inception of our CAMP, 320 patients have been referred for evaluation. A confirmed diagnosis of CA was made for 214 individuals (170 male) - 196 with ATTR CA, 15 with AL CA, 1 with AApoA-IV CA. The average age of the cohort with confirmed CA was 82.1 ± 9 years. Of the patients with TTR amyloid, 19 had hereditary ATTR. The most commonly identified pathological mutation was pV142I in 13 patients. Other identified mutations were p.Ala140Ser, p.V122I, pV30M mutation, pThr60Ala. Trends in referrals and diagnosis are described in the Illustration. We observed a slight decrease in referral rates below the projected trajectory in the months immediately following the COVID-19 pandemic, with a subsequent recovery (Illustration). The cumulative duration of follow-up was 266 patient years. A total of 1721 all-cause hospitalizations occurred during the duration of follow-up, averaging 6.5 admissions per person-year. The rates of all-cause hospitalizations were numerically higher for AL vs ATTR CA, but the difference was not statistically significant (median 18 vs 4, p=0.1). A total of 44 deaths occurred. Patients with ATTR CA had a significantly lower mortality than patients with AL CA (18% vs 53%, p=0.003). The growth of our dedicated CA program above predicted trends supports successful awareness about CA and the creation of a growing partnership in providing care with other providers in our community. [ABSTRACT FROM AUTHOR]