Substantial variation in healthcare infrastructure and access to specialized diagnostics continues to affect clinical management of transthyretin amyloid cardiomyopathy (ATTR-CM) in the Asia-Pacific (APAC) region. A modified Delphi consensus study, presented at the Heart Failure 2026, developed pragmatic regional recommendations to support earlier diagnosis, standardize care, and improve long-term management.

The consensus process involved 13 APAC-based cardiologists who addressed 89 clinical questions across six domains, including epidemiology and awareness, diagnosis and screening, treatment strategies, disease monitoring, long-term management, and future research priorities. Consensus was predefined as at least 70% agreement among panel members.

Findings

• Screening was recommended for patients aged 60 years or older with unexplained left ventricular wall thickness ≥12 mm and accompanying clinical red flags suggestive of amyloidosis.
• Bone scintigraphy combined with exclusion of amyloid light-chain amyloidosis was endorsed as the diagnostic standard for ATTR-CM.
• Single-photon emission computed tomography (SPECT) imaging was preferred over planar imaging when available.
• For patients eligible for disease-modifying therapy (DMT), lifelong treatment was recommended once initiated, with emphasis on early initiation because of potential prognostic benefit.
• Sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists were recommended as considerations for heart failure management alongside DMT.
• Anticoagulation was recommended for patients with atrial fibrillation regardless of conventional cardiovascular risk scores.

This APAC-focused Delphi consensus provides practical recommendations tailored to regional healthcare variability in the diagnosis and management of ATTR-CM.