A National Survey of VA to Assess Availability of Care for Patients With Cardiac Amyloidosis

BACKGROUND: Despite heightened awareness of cardiac amyloidosis (CA), the care of patients with CA remains challenging, particularly at the Veterans Affairs (VA), where populations are predominantly older and male. OBJECTIVES: This study aimed to characterize the current landscape of CA care across the VA. METHODS: As a quality improvement study, a survey instrument was developed and disseminated to all 127 VA cardiology programs from March to May 2025. The survey captured data on diagnostic modality availability, therapeutic resources, multidisciplinary care team composition, and self-designated amyloidosis center designation. RESULTS: Complete responses were received from 54 cardiology programs (42.5%). There was substantial variability in program-level experience, clinician comfort, access to diagnostics, and therapeutics regardless of clinical complexity index designation. Thirty-one survey respondents (57.4%) reported feeling "very comfortable" treating CA, although 7 (13.0%) reported being "hesitant" to provide care for Veterans with CA. Twelve programs (22.2%) reported having only one cardiologist managing CA patients, and 7 (13.0%) indicated that no cardiologists at their center treated Veterans with CA. Only 4 programs (7.4%) reported having a formalized multidisciplinary CA team. Lastly, facility complexity did not have an obvious relationship to size, scope, or readiness to care for Veterans with CA. CONCLUSIONS: The VA appears strongest at the initial diagnostic stages, with high availability to initiate a workup for transthyretin CA, with considerable latent capacity to support comprehensive CA care including a high-risk patient population, widespread diagnostic capabilities, national access to therapies, and robust telehealth infrastructure. Targeted implementation to standardize CA care delivery, while leveraging existing strengths, could meaningfully improve care for Veterans with CA.