Diagnostic Trends and Geographic Health Care Disparities Among Patients With Transthyretin Amyloid Cardiomyopathy

BACKGROUND: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a rare, life-threatening form of restrictive cardiomyopathy. Access to cardiology providers and specialized amyloid centers may impact ATTR-CM diagnosis. We sought to elucidate diagnostic disparities of ATTR-CM through assessment of diagnostic trends and the geographic distribution of amyloid centers and cardiology providers in the United States. METHODS: This was a cross-sectional geospatial analysis of amyloid centers and cardiology providers and a retrospective cohort analysis of patients with ATTR-CM from the Komodo Healthcare Map from July 1, 2016, to June 30, 2024. RESULTS: Among 14 980 patients, mean age was 74.8 years, 62.3% were men, 54.1% were White individuals, and 28.8% were Black individuals. The diagnosed prevalence of ATTR-CM was 35.68 per 100 000 persons. Prevalence was highest in Black patients (102.17) and in the Northeast (52.63), and it increased 4-fold over the study period. Mean distance of patients to a cardiology provider was 4.3 miles and to an amyloid center was 48.5 miles. Large areas of the country, particularly in the Midwest, were identified with limited cardiology providers and amyloid centers. CONCLUSIONS: The prevalence of ATTR-CM has increased substantially since 2017, with notable racial differences; however, there remain geographic disparities. Strategies to address these regional disparities need to be identified.