Cardiac amyloidosis: A survey of current awareness, diagnostic modalities, treatment practices, and clinical challenges among cardiologists in selected Middle Eastern countries

Abstract

Background: Cardiac amyloidosis (CA) is a chronic progressive disease caused by the deposition of amyloid fibrils in cardiac tissues. Diagnosis and management of CA are complicated and have developed over the years. Hypothesis: Middle Eastern countries have significant knowledge disparities in diagnosing, managing, and treating different subtypes of CA. Methods: An online survey was sent to cardiologists in four countries (Saudi Arabia, Lebanon, Egypt, and Iraq) interested in heart failure and practicing for more than a year. The survey questioned the characteristics of the participants and their institutions. It addressed their knowledge and practices in CA specifically diagnostic modalities, treatment options, and interest in education and knowledge exchange.Results: A total of 85 physicians participated in the survey. There was a variation in the participating cardiologists' knowledge, experience level, and readiness of their institutes to manage patients with ATTR-CM. Most participants believed that a high rate of ATTR-CM misdiagnosis existed. Participants' knowledge of the diagnostic modalities and "red flags" raising suspicion about ATTR-CM varied. Another challenge was the availability of essential diagnostic modalities among various cardiology centers. A knowledge gap was also observed regarding updates in ATTR-CM management. However, there was a high endorsement of the need for more education, physician networking, and knowledge exchange.Conclusions: This survey highlighted the need for increasing awareness levels among cardiologists in the four selected Middle Eastern countries. Cardiologists are most likely to benefit from additional training and knowledge exchange on the latest management advances of this disease. Thus, measures must be taken to focus on the

Transthyretin cardiac amyloidosis in Saudi Arabia and the Middle East: insights, projected prevalence and practical applications

“…Two recent physician surveys have investigated the barriers to the diagnosis of cardiac amyloidosis in the Middle East (10,11). Findings of both studies suggest that one major barrier lies in the lack of physician awareness and knowledge regarding symptoms and clinical findings that should raise suspicion for a diagnosis of ATTR-CA.…”

“…However, both surveys from the Middle East highlighted the lack of awareness among physicians regarding the utility of cardiac radionuclide scintigraphy imaging as well as the lack of access to such imaging modalities. Approximately one third of physicians in the surveys were unfamiliar with the role of cardiac radionuclide scintigraphy for the diagnosis of ATTR-CA, whereas 40% of physicians reported the availability of this imaging modality at their institutions (10,11). An approach to overcome this barrier to the diagnosis of ATTR-CA would be to encourage the establishment of regional centers with expertise in heart failure that are equipped with appropriate imaging modalities.…”

“…The underdiagnosis of ATTR-CA in the region has resulted in significant shortcomings in the management of the disease. Physician surveys emerging from the region highlighted deficiencies in the awareness of the management modalities for ATTR-CA (10). The recent development of transthyretin targeted therapies has revolutionized the treatment of the disease.…”

“…What is clear is that this condition remains underdiagnosed, and the vast majority of patients go undiagnosed. Recent studies conducted in the Middle East and the Gulf region demonstrate significant shortcomings regarding the diagnostic modalities and therapeutic approaches for cardiac amyloidosis, mainly due to a lack of awareness among health care professionals (10,11). Such underdiagnosis or misdiagnosis of ATTR-CA leads to a delay in instituting diseasemodifying therapies and thus has detrimental consequences on patient outcomes.…”

Best Practices in Nuclear Imaging for the Diagnosis of Transthyretin Amyloid Cardiomyopathy (ATTR-CM) in KSA: The Eagle Eyes of Local Experts

“…A survey of 85 cardiologists from Saudi Arabia, Egypt, Lebanon, and Iraq revealed that only 71% of the respondents had participated in educational meetings on amyloid cardiomyopathy in the last three years. These findings underscore the importance of raising awareness and standardizing the diagnostic process for cases with suspected cardiac amyloidosis [16]. This article presents the best practices for diagnosing ATTR-CM in the Kingdom of Saudi Arabia (KSA), formulated during an advisory board meeting following a secondary literature review.…”