A new study has revealed significant delays in the diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM) following an initial diagnosis of heart failure (HF), with the median time to diagnosis exceeding one year.¹ Timely identification of ATTR-CM is critical to reduce morbidity and mortality, as effective treatments are available.²

Methodology

This retrospective cohort study analysed data from the US Veterans Health Administration (VHA) between 2016 and 2022. Researchers identified 2,557 patients with diagnoses of both HF and ATTR-CM. The primary outcome was the time elapsed between a patient's first recorded HF diagnosis and their subsequent ATTR-CM diagnosis. The study also assessed predictors associated with a diagnostic delay of more than six months.¹

Results

The median time from an initial HF diagnosis to an ATTR-CM diagnosis was 490 days. For patients who had received a loop diuretic prescription prior to their ATTR-CM diagnosis, the median time from that first prescription was even longer, at 835 days. There was also significant variability in diagnostic timelines across different VHA sites, with median delays ranging from 169 to 1,070 days.

Multivariable analysis found that a history of atrial fibrillation (OR: 1.21), coronary artery disease (OR: 1.38), or chronic kidney disease (OR: 1.79) was associated with a longer time to diagnosis. Conversely, Black race (OR: 0.71) and older age (OR: 0.66) were associated with a shorter time to diagnosis.¹

In Practice

The presence of common cardiovascular comorbidities appears to contribute to diagnostic delays, potentially because symptoms are attributed to these other conditions. The study authors suggest these findings "uncover an opportunity for clinicians to consider concomitant ATTR-CM in patients with alternate aetiologies for their cardiomyopathy".¹ They highlight that expediting evaluation for ATTR-CM is critical to reducing the morbidity of this progressive condition, particularly in patients with HF who also have atrial fibrillation, coronary artery disease, or chronic kidney disease.

This study was supported by AstraZeneca.

References

1. Spencer-Bonilla G, Fan J, Cheng P, et al. Delayed Diagnosis of Transthyretin Amyloid Cardiomyopathy in the Veterans Health Administration. JACC. 2026;87(5):533–545. https://doi.org/10.1016/j.jacc.2025.10.021

2. Ruberg FL, Grogan M, Hanna M, et al. Transthyretin amyloid cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019;73(22):2872-2891. https://doi.org/10.1016/j.jacc.2019.04.003

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