Abstract 4144434: Cardiac Amyloidosis: Hidden in Plain Sight

Introduction: Cardiac amyloidosis (CA) is the most common cause of restrictive cardiomyopathy (CM). CA is most often due to deposition of transthyretin (ATTR-CM). ATTR-CM is prevalent in 10-14% of patients diagnosed with heart failure with preserved ejection fraction (EF > 50%) (HFpEF). Despite clinical advancements and increased awareness, CA remains under-detected. Questions: Are patients admitted with HFpEF being adequately screened for CA? Will an educational intervention and implementation of an electronic order set for CA improve screening rates? Goals: Identify screening rates for CA, and improve comfort level recognizing and screening for CA at a tertiary care institution. Methods: A retrospective review was conducted of patients admitted to an academic tertiary care hospital in New Jersey from 1/1/22-6/30/22 with a diagnosis of HFpEF. Data collected included previous diagnosis of CA, presence and results of a technetium-99m pyrophosphate (PYP) scan, serum and urine tests for monoclonal proteins (including electrophoresis with immunofixation and free kappa/lambda light chains ratio). An educational intervention was then provided to internal medicine (IM) residents regarding CA pathophysiology and screening (topics detailed in Figure 1). Pre- and post-intervention surveys were administered. Results were analyzed for significance with a paired t-test. Results: Of 498 patients admitted with HFpEF, only 23 (4.6%) were screened for a diagnosis of CA. Of those screened, only 14 (60%) received all appropriate diagnostic testing. The most often omitted test was the PYP scan in 30% of patients. IM residents reported modest comfort with CA screening before the intervention and a significant improvement after the intervention (Figure 1). Conclusion: Screening for CA in patients admitted with HFpEF is limited. An educational intervention significantly improved resident comfort level regarding screening for CA. Based on these findings, an electronic order set was created for comprehensive screening of CA; post-intervention screening rates will be assessed in the future.