{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:04:28Z","timestamp":1792785868025,"version":"4.5.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Pfizer and Eidos therapeutics"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) is increasingly recognized in older adults. Nonetheless, its true prevalence in unselected subjects is unclear. We performed a systematic screening in 1000 individuals aged 65\u201390 years to identify CA and assess the clinical and economic impact of diagnosing both CA and incidental findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>All participants underwent a cardiology visit, electrocardiogram, echocardiogram, and measurement of cardiac biomarkers. Patients with any red flag proceeded to bone scintigraphy and monoclonal protein testing. We catalogued incidental cardiac or renal abnormalities, referred individuals for further evaluation, and estimated total screening costs. We then incorporated tafamidis therapy for the newly diagnosed patients with CA and conducted two cost-effectiveness analyses: one excluding quality-adjusted life years (QALYs) from incidental diagnoses and another one including them. Four new cases of ATTRwt-CA were diagnosed (0.46%). Additional findings included moderate-to-severe valvular disease, conduction abnormalities requiring device implantation, and previously unknown Stage 3\u20135 chronic kidney disease in 15.6% of participants. The total non-drug screening cost was around \u20ac252 000, while tafamidis (5 years, four patients) added \u20ac1 080 000. Excluding incidental benefits, the incremental cost-effectiveness ratio (ICER) was around \u20ac94 000 per QALY. With an estimated 15\u201320 extra QALYs from incidental findings, the ICER fell to \u20ac39 000-\u20ac46 000 per QALY.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A structured screening programme for CA in elderly subjects can uncover important comorbidities but remains expensive, with an incremental cost of approximately \u20ac39 000\u2013\u20ac94 000 per QALY; the overall value of such a strategy will therefore depend on tafamidis pricing and the willingness-to-pay threshold adopted by individual health systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcaf166","type":"journal-article","created":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T12:42:52Z","timestamp":1767271372000},"page":"479-483","source":"Crossref","is-referenced-by-count":1,"title":["First systematic screening of cardiac amyloidosis in the elderly: findings and cost-effectiveness profile"],"prefix":"10.1093","volume":"12","author":[{"given":"Yu Fu","family":"Ferrari Chen","sequence":"first","affiliation":[{"name":"Interdisciplinary Center for Health Science, Scuola Superiore Sant\u2019Anna , Piazza Martiri della Libert\u00e0 33, Pisa 56127 ,","place":["Italy"]},{"name":"Cardiology Division, Fondazione Toscana Gabriele Monasterio , via Moruzzi 1, Pisa 56124 ,","place":["Italy"]},{"name":"Cardiology Division, University Hospital of Pisa , via Roma 55, Pisa 56126 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Castiglione","sequence":"additional","affiliation":[{"name":"Interdisciplinary Center for Health Science, Scuola Superiore Sant\u2019Anna , Piazza Martiri della Libert\u00e0 33, Pisa 56127 ,","place":["Italy"]},{"name":"Cardiology Division, Fondazione Toscana Gabriele Monasterio , via Moruzzi 1, Pisa 56124 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Francesca","family":"Orsino","sequence":"additional","affiliation":[{"name":"Cardiology Division, University Hospital of Pisa , via Roma 55, Pisa 56126 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Mori","sequence":"additional","affiliation":[{"name":"Cardiology Division, University Hospital of Pisa , via Roma 55, Pisa 56126 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Passino","sequence":"additional","affiliation":[{"name":"Interdisciplinary Center for Health Science, Scuola Superiore Sant\u2019Anna , Piazza Martiri della Libert\u00e0 33, Pisa 56127 ,","place":["Italy"]},{"name":"Cardiology Division, Fondazione Toscana Gabriele Monasterio , via Moruzzi 1, Pisa 56124 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Piepoli","sequence":"additional","affiliation":[{"name":"Clinical Cardiology, IRCCS Policlinico San Donato , Piazza Edmondo Malan 2, Milan 20097 ,","place":["Italy"]},{"name":"Department of Biomedical Sciences for Health, University of Milan , via Festa del Perdono 7, Milan 20122 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Emdin","sequence":"additional","affiliation":[{"name":"Interdisciplinary Center for Health Science, Scuola Superiore Sant\u2019Anna , Piazza Martiri della Libert\u00e0 33, Pisa 56127 ,","place":["Italy"]},{"name":"Cardiology Division, Fondazione Toscana Gabriele Monasterio , via Moruzzi 1, Pisa 56124 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