Abstract 4144868: Optimizing the Care of Patients with Cardiac Amyloidosis in a Safety Net Hospital: A Multidisciplinary Heart Team Approach

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Introduction Cardiac Amyloidosis is often underdiagnosed due to the heterogeneity of clinical presentation, disease rarity, and clinician unfamiliarity with diagnosis and management. Studies have shown that timely diagnosis and effective treatment can prolong median survival in patients with cardiac amyloidosis. By optimizing cardiovascular care, multidisciplinary heart teams play a significant role in cardiovascular disease management. We describe a multidisciplinary heart team (MDHT) based approach to the diagnosis and management of suspected cases of cardiac amyloidosis in a safety net hospital. Methods: A MDHT working group of cardiologists, hematologists/oncologists, nuclear medicine physicians, radiologists, pathologists, nephrologists, advanced practice practitioners, and pharmacists was established to optimize the clinical care of patients with amyloidosis. Virtual monthly interdisciplinary meetings were held from January 2022 to May 2024 to review clinical cases, discuss diagnostic and treatment plans, review cardiac imaging, and implement best clinical practices to improve patient outcomes. Cases were identified based on referrals and consultations.The clinical case presentation was led by cardiology and hematology/oncology fellows. The ACC Cardiac Amyloidosis Expert Consensus Decision Pathway was used to guide management. Results: Of the 95 patients who were suspected to have amyloidosis, 44.2% (n=42) were female, and 91.6% self-identified as Black, the median age was 70.5 years. For diagnostic testing, 32.6% (n=31) underwent a PYP scan after light chain AL amyloidosis was rulled out, and 15 patients(15.8%) underwent either cardiac or bone marrow biopsy for concerns of AL amyloidosis. Of the total cohort, 26.32% (n=25) had hereditary transthyretin amyloidosis (hATTR), and 3.16% (n = 3) had AL amyloidosis. Of the patients with confirmed amyloidosis (29.47%, n=28), 67.9% (n=19) received medical therapy [53.57% (n=15) received Tafamidis for hATTR cadiomyopathy and 7.1% (n=2) received chemotherapy for light chain AL amyloidosis. Conclusion: A multidisciplinary heart team approach resulted in the diagnosis of cardiac amyloidosis in 26% of our cohort with 68% of the cohort receiving medical treatment. This collaboration has facilitated patient-centered care, comprehensive evaluation and personalized treatment plans for patients with suspected cardiac amyloidosis and also provided educational opportunities for trainees.

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