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The estimated survival time from diagnosis is approximately 3\u20136 years. Because of the non-specificity of initial symptom manifestation and insufficient awareness among treating physicians, approximately one-third of patients with ATTRwt-CM are initially misdiagnosed with other cardiac diseases. Although heart failure (HF) is the most common initial manifestation of ATTRwt-CM, observed in nearly 70% of affected patients, patients may also present with other cardiologic symptoms, such as atrial fibrillation (AF) and aortic stenosis (AS). This non-specific and diverse nature of the initial ATTRwt-CM presentation indicates that various cardiology subspecialties are involved in patient diagnosis and management. Standard guideline-directed pharmacological treatment for HF is not recommended for patients with ATTRwt-CM because of its limited effectiveness. However, no established algorithms are available regarding HF management in this patient population. This literature review provides an overview of the red flags for ATTRwt-CM and research findings regarding HF management in this patient population. In addition to commonly recognized red flags for ATTRwt-CM (e.g., HF, AF and severe AS), published literature identified potential red flags such as coronary microvascular dysfunction. For HF management in patients with ATTRwt-CM, the use of mineralocorticoid receptor antagonists (MRAs) was reported as a well-tolerated option associated with a low discontinuation rate and reduced mortality. Although there is no concrete evidence for recommendations against sodium-glucose cotransporter 2 inhibitor (SGLT2i) administration, research supporting its use is limited to small-scale studies. Robust evidence is lacking for AF ablation, implantable cardioverter-defibrillators and cardiac resynchronization therapy. Based on the published findings and our clinical experience as Japanese ATTRwt-CM experts, red-flag symptom clusters for each cardiology specialty (HF, arrhythmia and ischaemia\/structural heart disease) and a treatment scheme for HF management are presented. As this research area remains at an exploratory stage, our observations would require further discussion among experts worldwide.<\/jats:p>","DOI":"10.1002\/ehf2.15016","type":"journal-article","created":{"date-parts":[[2024,8,21]],"date-time":"2024-08-21T23:13:31Z","timestamp":1724282011000},"page":"955-967","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Transthyretin Amyloid Cardiomyopathy: Literature Review and Red-Flag Symptom Clusters for Each Cardiology Specialty"],"prefix":"10.1093","volume":"12","author":[{"given":"Yasuhiro","family":"Izumiya","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine , Osaka ,","place":["Japan"]},{"name":"Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University , Kumamoto 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