Temporal Trends in Incidence and Prevalence of Transthyretin Amyloid Cardiomyopathy in the United States

BACKGROUND: Advances in diagnosis and disease awareness have led to increased prevalence and incidence of transthyretin amyloid cardiomyopathy (ATTR-CM), but current US population-based epidemiologic data are lacking. This study aimed to estimate temporal trends and current prevalence and incidence of ATTR-CM in the United States and to describe patient characteristics and the clinical burden. METHODS: Data from the US Merative MarketScan Medicare Database (2010-2021) and the IQVIA PharMetrics Plus (2016-2023) claims database were assessed. An algorithm using codes for diagnoses and clinical drugs was used to identify patients with ATTR-CM among individuals ≥18 years old. Incidence, prevalence, demographics, comorbidities, medication use, and clinical encounters were assessed annually in cross-sectional cohorts. RESULTS: The incidence and prevalence of ATTR-CM became higher over time, particularly in men and older age groups. The incidence per 100 000 person-years was 44.3 (95% CI, 39.4-49.2) in 2021 for the Medicare Database (individuals aged ≥65 years) and 5.4 (95% CI, 5.0-5.8) in 2022 for PharMetrics Plus (individuals aged ≥18 years); the prevalence per 100 000 individuals was 95.8 (95% CI, 89.2-102.4) in 2022 in the Medicare Database and 11.3 (95% CI, 10.8-11.8) in 2023 in PharMetrics Plus. The number of comorbidities and medication use in the year before diagnosis increased over time; the number of clinical encounters in the year before diagnosis was relatively stable. CONCLUSIONS: The incidence and prevalence of ATTR-CM diagnoses have increased in the United States from 2010 to 2023, and the clinical burden among newly diagnosed individuals has become more complex.