A retrospective cohort study published in the JAMA Cardiology assessed diagnostic timelines for transthyretin cardiac amyloidosis (ATTR-CM) among patients with heart failure (HF) using U.S. Medicare fee-for-service data from January 2016 to December 2022. Eligible participants included beneficiaries diagnosed with both HF and ATTR-CM, with ATTR-CM occurring after HF diagnosis or within one year prior. 

The primary outcome was time from first HF diagnosis to ATTR-CM diagnosis, measured in days. Delayed diagnosis was defined as more than 6 months between HF and ATTR-CM diagnosis. Multivariable logistic regression was used to evaluate demographic, clinical, and socioeconomic predictors of delayed diagnosis.

A total of 7,770 patients met inclusion criteria, with a median age of 81 years (interquartile range [IQR] 76–86), and 77% were male. The median time from HF diagnosis to ATTR-CM diagnosis was 494 days (IQR 63–1340). Among 6,175 patients prescribed loop diuretics before ATTR-CM diagnosis, the median time from initial prescription to diagnosis was 840 days (IQR 252–1768). =

Factors associated with lower odds of delayed diagnosis included older age (odds ratio [OR] 0.68; 95% CI 0.63–0.74), atrial fibrillation (AF) (OR 0.39; 95% CI 0.33–0.49), and carpal tunnel syndrome (OR 0.85; 95% CI 0.74–0.97). Higher odds of delayed diagnosis were observed in females (OR 1.28; 95% CI 1.13–1.45) and in those with aortic stenosis (OR 1.39), coronary artery disease (CAD) (OR 1.26), diabetes (OR 1.21), hypertension (OR 1.28), and chronic obstructive pulmonary disease (COPD) (OR 1.18).

Substantial delays were observed between HF onset and ATTR-CM diagnosis. These findings indicate variability in diagnostic timing across clinical subgroups.