Managing Cardiac Amyloidosis in a Rural Cardiology Practice: Bridging Gaps in Specialized Evaluation and Disease-Modifying Treatment.

Cardiac amyloidosis is an underdiagnosed condition characterized by the deposition of amyloid fibrils in the myocardium. Its timely diagnosis remains challenging, particularly in a rural cardiology setting where access to advanced imaging, tissue biopsy, and genetic evaluation is often limited. Early initiation of disease-modifying therapy is critical; however, real-world guidance for clinicians practicing outside tertiary centers is sparse. We describe three consecutive patients diagnosed with cardiac amyloidosis in a rural cardiology clinic, each presenting with non-specific heart failure symptoms that masked classic red-flag features of cardiac amyloidosis. Despite resource constraints, all patients were effectively evaluated using a streamlined diagnostic pathway. Disease-modifying therapy was initiated promptly. This case series demonstrates that early recognition and effective management of cardiac amyloidosis can be achieved in rural settings using a practical and reproducible protocol. We present our experience as a real-world framework to help rural clinicians identify and treat amyloidosis at the earliest opportunity with the aim of improving patient outcomes.