Clinical Scorecard: Mortality Trends and Disparities in Cardiovascular Disease and Amyloidosis: A Retrospective Population Study in the United States (1999–2020)

At a Glance

Key Highlights

• Amyloidosis, particularly ATTRwt and ATTRv, is increasingly recognized as a contributor to cardiovascular morbidity and mortality.
• Age-adjusted mortality rates for amyloidosis and CVD-related deaths increased from 4.4 to 9.31 per 1,000,000 between 1999 and 2020.
• Racial disparities exist, with Black patients more affected by hereditary ATTRv and experiencing worse outcomes including higher in-hospital mortality.

Guideline-Based Recommendations

Diagnosis

• Utilize advanced diagnostic modalities such as cardiac MRI, bone scintigraphy, and AI-assisted imaging for early and accurate detection of cardiac amyloidosis.
• Consider amyloidosis in differential diagnosis of older adults with HFpEF or unexplained cardiac symptoms.

Management

• Implement disease-modifying therapies including next-generation TTR stabilizers (e.g., acoramidis) and RNA-silencing agents (e.g., patisiran) to reduce mortality and morbidity in ATTR cardiomyopathy.
• Address coexisting cardiovascular conditions with standard care alongside amyloidosis-specific treatments.

Monitoring & Follow-up

• Monitor clinical progression and response to therapy in amyloidosis patients with cardiovascular involvement.
• Track demographic and geographic disparities to improve equitable access to diagnostics and treatments.

Risks

• Underdiagnosis due to nonspecific symptoms or overlap with other cardiac conditions.
• Increased mortality and complications in Black patients due to genetic predisposition and systemic healthcare disparities.

Patient & Prescribing Data

Patients with ATTR cardiomyopathy, particularly older adults and those with hereditary mutations

Newly approved TTR stabilizers and RNA-silencing therapies have demonstrated mortality and morbidity benefits, marking a shift from palliative to disease-modifying treatment.

Clinical Best Practices

• Maintain high clinical suspicion for amyloidosis in older adults with HFpEF or unexplained cardiac symptoms.
• Use sensitive and specific imaging modalities to confirm diagnosis.
• Incorporate novel disease-modifying therapies early to improve outcomes.
• Address racial and socioeconomic disparities by improving access to advanced diagnostics and treatments.
• Utilize population-level data to inform public health strategies and resource allocation.

References

• CDC WONDER Database
• ICD-10 Codes for Amyloidosis and Cardiovascular Diseases
• Joinpoint Regression Program