Nursing-led screening found a 5% prevalence of ATTR-CA in 150 heart failure hospitalizations, with 17% of 53 screened patients diagnosed, mostly elderly males.
What is the prevalence of cardiac amyloidosis in patients hospitalized for heart failure when actively screened by nursing staff using clinical red flags?
Active screening by nursing staff using clinical red flags and echocardiographic criteria identified a 5% prevalence of ATTR-CA among patients hospitalized for heart failure.
Absolute Event Rate: 0% vs 0%
Abstract Introduction -Cardiac amyloidosis (CA) is a fatal disease caused by the deposition of amyloid fibers in the heart, resulting in infiltrative restrictive cardiomyopathy. The prognosis depends on the subtype, with AL being the one that has a more aggressive course without treatment. In these patients, it is key to shorten the time between the onset of symptoms and their diagnosis. On the other hand, ATTR-CA has undergone a revolution in terms of therapeutic options. Currently, there are specific treatments that seem to slow the course of the disease and reduce complications, even in the wild type ATTR-CA. Purpose -Study the prevalence of CA in patients admitted due heart failure (HF) hospitalization and to establish the usefulness of clinical scales that allow studying the prevalence of CA in these kind of patients made by the nurse staff. Material and methods -Patients admitted due to HF in the cardiology ward were screened for CA. -All patients went through a questionnaire in which clinical history, data from the electrocardiogram, echocardiogram , renal function, NT- proBNP and troponin I were collected. -Agreed clinical red flags of CA were the next ones: history of previous pacemaker; carpal tunnel syndrome; back pain of lumbar stenosis; orthostatic hypotension; popeye sign or neurological symptoms. -Referral criteria: left ventricular wall thickness equal to or greater than 12mm on echocardiography and the presence of 2 or more clinical red flags. If the suspicion of CA was positive, a DPD scintigraphy in addition to serum and urine immunofixation electrophoresis and serum-free light chain assay were performed and then evaluated by the amyloidosis clinic. Results -Among the 150 patients included, of whom 53 underwent further screening for cardiac amyloidosis. A total of 9 patients (17%) were diagnosed with ATTR-CA which would be a 5% of the entire sample size. none below 75 years. Of them, 77% were male, with a mean age of 87.78± 4.18 years, mean left ventricle ejection fraction of 43.74±10.85% and a mean maximum left ventricle wall thickness of 15.99 13.3-18 mm. There was no statistical difference in the prevalence of ATTR-CA by sex (29.16% for men and 10.5% for women, P=.145). None of the patients exhibited a genetic variant (ATTRv). The most predominant red flag in our ATTR-CA patients was popeye sign and, the least, the history of carpal tunnel syndrome. Conclusions -Nursing has an essential role in the active search for patients with a possible diagnosis of CA. Specific training is mandatory. We highlight the importance and value of teamwork, in order to screen the greatest number of patients with a possible diagnosis of CA.Red flags Results
Sanchez et al. (Sat,) reported a other. Nursing-led screening found a 5% prevalence of ATTR-CA in 150 heart failure hospitalizations, with 17% of 53 screened patients diagnosed, mostly elderly males.