Trends in diagnostic testing in Medicare patients with wild-type transthyretin amyloid cardiomyopathy.

Background: Most patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) are diagnosed noninvasively, using nuclear imaging and monoclonal protein testing. However, concerns have been raised that some may receive an ATTRwt-CM diagnosis based on incomplete evaluations (not based on current consensus recommendations). Using a cohort of US Medicare Fee-for-Service patients, we aimed to examine the frequency and cadence of diagnostic testing for ATTRwt-CM. Methods: In this retrospective observational cross-sectional study, administrative de-identified claims data from 2018 to 2022 were derived from patients aged ≥65 years who had at least one 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. Annual new ATTRwt-CM diagnoses nearly tripled over the study period (2018, Conclusions: Based on Medicare claims data, most patients diagnosed with ATTRwt-CM have not been diagnosed following consensus-recommended pathways.