Diagnostic pathway for cardiac amyloidosis from the healthcare professional’s perspective: results from the French DIAM-ATTR survey

Diagnosis of cardiac amyloidosis (CA) is complex and implicates several medical specialists. CA is usually suspected based on symptoms (‘red flags’) and non-invasive imagery. Early diagnosis and appropriate treatment are critical in patients with CA.
The DIAM-ATTR survey assessed the diagnostic pathway, from the French healthcare professional’s (HCPs) perspective, for patients with transthyretin amyloidosis (ATTR)-cardiomyopathy (CM). Between February and March 2023, 13,830 HCPs were solicited to complete a 35-question survey.
Among the 13,830 HCPs solicited, 1264 HCPs completed the survey: 471 cardiologists, 186 internists, 148 nuclear medicine physicians, 125 geriatricians, 120 orthopaedic surgeons, 112 neurologists, and 102 rheumatologists. In general, echocardiographic abnormalities, heart failure, and a family history of amyloid neuropathy evoked CA. The knowledge of the 22 ‘red flags’ assessed varied among specialists. Among HCPs, 70% had suspected an ATTR-CM: from 96% of cardiologist to 6% of orthopaedic surgeons. Complete diagnosis was performed by 48% of both cardiologists and internists. The other HCPs referred patients to colleagues for complete diagnosis. Overall, echocardiography was performed first, then gammopathy assessment and bone scintigraphy. Delays for examinations and difficulties varied among specialists.
Overall, French HCPs prioritize diagnostic examinations for ATTR-CM as recommended. However, HCPs need an increased awareness of ‘red flags’ and the importance of excluding monoclonal gammopathies during diagnosis.