Background: Although most patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) are diagnosed noninvasively, concerns have been raised that many may be receiving the diagnosis with incomplete evaluations (i.e., not based on consensus recommendations). Using a cohort of US Medicare fee-for-service patients, we explored the frequency and cadence of diagnostic testing for ATTRwt-CM.
Methods: In this retrospective observational study, administrative de-identified claims data were derived from patients aged ≥65 years who had ≥1 claim for ATTRwt-CM and heart failure or cardiomyopathy, and ≥2 years of continuous Medicare enrollment before the first ATTRwt-CM diagnosis. Patients with claims for any other form of amyloidosis, multiple myeloma, or plasma cell dyscrasias were excluded.
Results: Among 2,050 patients with ATTRwt-CM, mean (SD) age was 80.0 (6.9) years, and 75.5% were men. Less than half of these patients had serum free light chain testing (46.2%), and about one-fifth had complete monoclonal protein testing (21.5%). A small minority (14.4%) underwent recommended noninvasive diagnostic testing comprised of complete monoclonal protein testing and PYP scintigraphy. Total new ATTRwt-CM diagnoses/year nearly tripled from 2018 (n=198) to 2022 (n=578 [Figure]). Cardiac biopsy use declined from 14.1% in patients diagnosed in 2018 to 5.4% in those diagnosed in 2022. Technetium-99m pyrophosphate (PYP) scintigraphy use peaked in patients diagnosed in 2020 (52.3%); it was performed in approximately half of diagnosed patients by the end of the study period (2018, 30.3%, 2022, 49.0%).
Discussion: Based on Medicare claims data, most patients diagnosed with ATTRwt-CM have not been diagnosed utilizing consensus recommended pathways.

**Background:** Although most patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) are diagnosed noninvasively, concerns have been raised that many may be receiving the diagnosis with incomplete evaluations (i.e., not based on consensus recommendations). Using a cohort of US Medicare fee-for-service patients, we explored the frequency and cadence of diagnostic testing for ATTRwt-CM.
**Methods:** In this retrospective observational study, administrative de-identified claims data were derived from patients aged ≥65 years who had ≥1 claim for ATTRwt-CM and heart failure or cardiomyopathy, and ≥2 years of continuous Medicare enrollment before the first ATTRwt-CM diagnosis. Patients with claims for any other form of amyloidosis, multiple myeloma, or plasma cell dyscrasias were excluded.
**Results:** Among 2,050 patients with ATTRwt-CM, mean (SD) age was 80.0 (6.9) years, and 75.5% were men. Less than half of these patients had serum free light chain testing (46.2%), and about one-fifth had complete monoclonal protein testing (21.5%). A small minority (14.4%) underwent recommended noninvasive diagnostic testing comprised of complete monoclonal protein testing and PYP scintigraphy. Total new ATTRwt-CM diagnoses/year nearly tripled from 2018 (n=198) to 2022 (n=578 [**Figure**]). Cardiac biopsy use declined from 14.1% in patients diagnosed in 2018 to 5.4% in those diagnosed in 2022. Technetium-99m pyrophosphate (PYP) scintigraphy use peaked in patients diagnosed in 2020 (52.3%); it was performed in approximately half of diagnosed patients by the end of the study period (2018, 30.3%, 2022, 49.0%).
**Discussion:** Based on Medicare claims data, most patients diagnosed with ATTRwt-CM have not been diagnosed utilizing consensus recommended pathways.

Trends in Diagnostic Testing in Medicare Patients with Wild-Type Transthyretin Cardiac Amyloidosis PB73 (#234)

We invite you to attend the XIX International Symposium on Amyloidosis to be held in Rochester, MN.

This symposium is organized as a hybrid meeting (with the focus on in-person) held from Sunday, May 26 through Thursday, May 30, 2024.

Together with the ISA Board and members of Mayo Clinic, a very attractive scientific hybrid program is being planned. The program will cover a variety of types of systemic amyloidosis: ATTR (hereditary and wild-type), AL (light-chain), AA and less frequent forms. There will be key lectures, specific symposia including those company sponsored, oral presentations and poster sessions of accepted abstracts.

COURSE DESCRIPTION
This program will provide a comprehensive review of state-of-the-art education in systemic amyloidosis: basic science, pathophysiology, diagnosis, current and emerging treatments. Scientific presentations will include competitive oral and poster abstracts. The rapid evolution of scientific discovery and expanding treatment options has created tremendous interest in the field and this meeting will fill and important gap in educating scientists and clinicians.