Healthcare resource use associated with the diagnosis of transthyretin amyloidosis cardiomyopathy

Asher, Clint; Guilder, Andrew; Finocchiaro, Gherardo; Carr‐White, Gerry; Rodriguez-Guadarrama, Yael

doi:10.1002/hsr2.466

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…Diagnostic delay in ATTR wt not only precludes adequate therapy, including tafamidis, but also increases healthcare costs. 17 This method could be one of the clues for early diagnosis of ATTR wt .…”

Section: Discussionmentioning

confidence: 99%

“…To our best knowledge, this study is the first report about the usefulness of deep breath induced CVR‐R fluctuation in the patients with ATTR wt . Diagnostic delay in ATTR wt not only precludes adequate therapy, including tafamidis, but also increases healthcare costs 17 . This method could be one of the clues for early diagnosis of ATTR wt .…”

Section: Discussionmentioning

confidence: 99%

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Coefficient of R‐R interval variations under deep breathing load in patients with wild‐type transthyretin amyloid cardiomyopathy: A case‐control study

Nagayoshi

Kawano

Nishihara³

et al. 2022

Health Science Reports

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Background and Aims: An autonomic nervous disorder is an important characteristic of cardiac amyloidosis; however, the prevalence of autonomic dysfunction in wild-type transthyretin amyloidosis (ATTR wt ) has not been established. Analysis of the R-R interval coefficient of variation (CVR-R) is a noninvasive method to measure parasympathetic activity. We aimed to assess autonomic dysfunction of ATTR wt and determine the utility of CVR-R for the detection of ATTR wt in other cardiac diseases.Methods: This is a single-center, retrospective, case-control study. Fifty patients with heart failure (HF) were studied. The etiologies of HF were as follows: ATTR wt , n = 10; previous myocardial infarction (MI), n = 20; and left ventricular hypertrophy (LVH) due to other disease processes (e.g., aortic stenosis), n = 20. We measured the CVR-R at rest (CVR-R rest ), CVR-R with deep breaths (CVR-R breath ), and the change rate (CVR-R diff rate) . The relative change formula is as follows: CVR-R diff rate = (CVR-R breath − CVR-R rest )/CVR-R rest × 100 (%).Results: There was no difference in the CVR-R rest levels among the three groups.The CVR-R diff rate levels in the ATTR wt group were significantly lower (ATTR wt : −8.77

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Coefficient of R‐R interval variations under deep breathing load in patients with wild‐type transthyretin amyloid cardiomyopathy: A case‐control study

Nagayoshi

Kawano

Nishihara³

et al. 2022

Health Science Reports

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Healthcare resource use associated with the diagnosis of transthyretin amyloidosis cardiomyopathy

Asher

Guilder

Finocchiaro

et al. 2022

Health Science Reports

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Objectives Our primary aim was to evaluate the healthcare resource use associated with the diagnosis of transthyretin amyloidosis cardiomyopathy. Second, we aim to assess the effect of the number of diagnostic tests and clinical contact points on the total time and costs between symptom onset and diagnosis defining a quantitative hypothetical optimized diagnostic pathway. Setting Clinical and cost data were collected from patients presenting between 2010 and 2018 in a tertiary referral institution in South London involving two participating hospitals. Participants Thirty‐eight adult patients with a definite diagnosis of transthyretin amyloidosis cardiomyopathy were included, mostly male (n = 28, 74%) and of African‐Caribbean descent (n = 23, 64%). We excluded patients without a confirmed transthyretin amyloidosis cardiomyopathy or those on inotersen, patisiran, or diflunisal at point of referral. Primary and secondary outcome measures The average time between first presentation and final diagnosis, and the cost per patient per month. By comparing to a more optimal clinical pathway towards diagnosis, we considered what could be the theoretical gain in terms of time to diagnosis and financial savings. Results The average time between first presentation and final diagnosis was 2.74 years. The average cost per patient per month was higher with progressive heart failure symptoms. A hypothetical optimal pathway reduces time to diagnosis of 1.65 to 1.74 years per patient. The potential financial savings are estimated within the range of £3000 to £4800 per patient. Conclusions Patients diagnosed with transthyretin amyloidosis cardiomyopathy have substantial healthcare resource utilization and costs starting from symptom onset. Higher costs were observed with progression in symptoms and appear linked to a delayed diagnosis. The number of additional diagnostic tests and clinical contact points may contribute to this and could represent a path to explore further for important health and cost savings, with more efficient pathways for these patients to be managed.

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Effect of Diflunisal in Patients with Transthyretin Cardiomyopathy: A Pilot Study

Camblor Blasco,

Devesa,

Nieto Roca

et al. 2024

JCM

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Background: ATTR-CM is becoming more prevalent, and disease-modifying therapy has been investigated in recent years with promising results. Diflunisal has shown TTR-stabilizing properties assessed by biomarkers and echocardiography, but there are no trials addressing the evolution of morphological changes with CMR. Methods and Results: AMILCA-DIFLU is an exploratory pilot study prospective, single-center, non-randomized, open-label clinical trial. Patients diagnosed with ATTR-CM underwent clinical, functional, biochemical and imaging assessment before and one year after diflunisal therapy initiation. Of the twelve ATTR-CM patients included, only nine patients completed treatment and study protocol in 12 months. To increase the sample size, we included seven real-world patients with one year of diflunisal treatment. Among the group of patients who completed treatment, diflunisal therapy did not show improvement in cardiac disease status as assessed by many cardiac and inflammatory biomarkers, 6MWT and CMR parameters after one year of treatment. However, a non-significant trend towards stabilization of CMR parameters such as LVEF, ECV and T2 at one year was found. When comparing the group of patients who completed diflunisal therapy and those who did not, a significant decrease in the distance performed in the 6MWT was found in the group of patients who completed treatment at one year (−14 ± 81.8 vs. −173 ± 122.2; p = 0.032). Diflunisal was overall well tolerated, showing only a statistically significant worsening in renal function in the group of diflunisal-treatment patients with no clinical relevance or need for treatment discontinuation. Conclusions: In patients with ATTR-CM, treatment with diflunisal was overall well tolerated and tended to stabilize or slow down amyloid cardiac disease progression assessed by CMR parameters, cardiac and inflammatory biomarkers and functional capacity.

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Healthcare resource use associated with the diagnosis of transthyretin amyloidosis cardiomyopathy

Cited by 3 publications

References 23 publications

Coefficient of R‐R interval variations under deep breathing load in patients with wild‐type transthyretin amyloid cardiomyopathy: A case‐control study

Coefficient of R‐R interval variations under deep breathing load in patients with wild‐type transthyretin amyloid cardiomyopathy: A case‐control study

Healthcare resource use associated with the diagnosis of transthyretin amyloidosis cardiomyopathy

Effect of Diflunisal in Patients with Transthyretin Cardiomyopathy: A Pilot Study

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