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

Q: What are the key findings of this study?

A national survey of 54 VA cardiology programs revealed substantial variability in cardiac amyloidosis care, with 57.4% of respondents feeling very comfortable treating the disease but only 7.4% reporting a formalized multidisciplinary team.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiac Amyloidosis (n=54). Intervention: Survey of cardiac amyloidosis care availability. Primary outcome: Availability of diagnostic modalities, therapeutic resources, multidisciplinary care team composition, and self-designated amyloidosis center designation.

Q: What does this research mean for the field?

A national survey of 54 VA cardiology programs revealed substantial variability in cardiac amyloidosis care, with only 7.4% reporting a formalized multidisciplinary team. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Sang Gune K. Yoo; Amen B. Zelleke; Kavita Khaira; Sandesh Dev; Nishant R. Shah; Joshua D. Mitchell; Alberta Warner; Ali Javaheri; Jonathan D. Moreno

doi:10.1016/j.jacadv.2026.103169

August 20, 2026JACC AdvancesOpen Access

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

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Key result

VA survey reveals substantial cardiac amyloidosis care variability, with only ~7% having multidisciplinary teams.

n=54

Figures

Graphical abstract published by JACC Advances — Graphical abstract · Published by JACC Advances · CC BY-NC-ND

Why the study?

Care of patients with cardiac amyloidosis remains challenging, particularly across the VA where populations are predominantly older and male.

Key Points

To characterize the national landscape of clinical resources, diagnostic modalities, multidisciplinary staffing, and care readiness for cardiac amyloidosis across Veterans Affairs cardiology programs.
Disseminated a quality improvement survey instrument to all 127 Veterans Affairs cardiology programs across 18 regional networks between March and May 2025.
Collected facility-level data on diagnostic modality availability, clinical staffing, provider comfort, therapeutic resources, and amyloid center self-designation.
Complete responses were received from 54 cardiology programs (42.5%), with 57.4% (n=31) reporting feeling 'very comfortable' treating cardiac amyloidosis and 13.0% (n=7) reporting being 'hesitant'.
Only 7.4% of programs (n=4) reported a formal multidisciplinary cardiac amyloidosis team, while 22.2% (n=12) had only one cardiologist managing these patients and 12.9% (n=7) had none.
Core diagnostic tools were widely accessible, including echocardiography with strain (94.4%, n=51) and nuclear scintigraphy (85.2%, n=46), but 42.6% (n=23) reported no access to mass spectrometry.

Study Design

Type

Cross-Sectional (n=54)

Multicenter

Yes

Structured PICO

P

Population

54 Veterans Affairs cardiology programs surveyed to assess the availability of care, diagnostic modalities, and therapeutic resources for patients with cardiac amyloidosis.

O

Outcome

Availability of diagnostic modalities, therapeutic resources, multidisciplinary care team composition, and self-designated amyloidosis center designation

There is substantial variability in the availability of multidisciplinary care and advanced diagnostics for cardiac amyloidosis across the VA system, highlighting opportunities for standardized care delivery.

Limitations

Response rate < 50%
Self-reported data subject to responder bias
Single respondent per facility may not capture intra-institutional variation
Survey addressed both AL and ATTR CA together
Access to ATTR-directed therapies is evolving rapidly
Survey responses were based on self-reported data and subject to responder bias
Only a single respondent per facility was surveyed
Survey addressed care for both AL and ATTR CA, which may obscure ATTR-specific findings
Access to ATTR-directed therapies is evolving rapidly and reported availability may change

Implication

Inconsistent VA amyloidosis care warrants caution assuming uniform expertise; leaves open whether formalized teams improve outcomes.

Abstract

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.

Discussion

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Cite This Study

Yoo et al. (2026) conducted a cross-sectional in Cardiac Amyloidosis (n=54). Survey of cardiac amyloidosis care availability was evaluated on Availability of diagnostic modalities, therapeutic resources, multidisciplinary care team composition, and self-designated amyloidosis center designation. A national survey of 54 VA cardiology programs revealed substantial variability in cardiac amyloidosis care, with 57.4% of respondents feeling very comfortable treating the disease but only 7.4% reporting a formalized multidisciplinary team.

synapsesocial.com/papers/6a8aad667677a3411444588f https://doi.org/10.1016/j.jacadv.2026.103169

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

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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