{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T18:46:29Z","timestamp":1782499589692,"version":"3.54.5"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardiac Amyloidosis (CA), specifically Transthyretin Amyloid Cardiomyopathy (ATTR-CM), is an under-recognized, progressive, and fatal disease. Comprehensive primary data describing awareness, attitudes, and barriers to treatment in Latin America (LATAM) are lacking, highlighting a gap between guidelines and real-world clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional, questionnaire-based observational study was conducted among 470 physicians actively involved in patient management across 8 LATAM countries (June-August 2023). The study assessed their awareness, attitudes, and barriers concerning ATTR-CM. Descriptive analysis was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Limited knowledge of ATTR-CM was observed. Awareness of its pathophysiology was reported by 50.2%. Patients consulted 4\u20135 physicians before receiving a confirmed diagnosis. Cardiologists managed most day-to-day cases (76.2%). Transthyretin genetic testing was available to only 26.4%. Local treatment protocols relied on international guidelines (87.4%), with Real-World Data considered important by 60.6%. Patient cost and access to tafamidis were frequently reported barriers. Follow-up commonly relied on echocardiography,\u00a0NT-pro BNP, NYHA classification, and ECG\/Holter ECG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Difficulties in ATTR-CM diagnosis and management in LATAM were influenced by varying knowledge levels, gaps in diagnostic algorithms, and significant access barriers. These factors contribute to delayed diagnosis and management. Enhanced, tailored training strategies and collaborative efforts are necessary to improve early diagnosis, effective treatment, and ultimately, patient outcomes in the region.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0351224","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T17:50:46Z","timestamp":1782496246000},"page":"e0351224","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Awareness, attitudes, and barriers toward Transthyretin Amyloid Cardiomyopathy in Latin America: A questionnaire-based cross-sectional study"],"prefix":"10.1371","volume":"21","author":[{"given":"Cecilia","family":"Camacho-Hubner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcia","family":"Waddington-Cruz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Juliana","family":"Rodr\u00edguez-Gonz\u00e1lez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Vinicius Sim\u00f5es","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan David","family":"L\u00f3pez-Ponce de Le\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Fernandes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1670-2715","authenticated-orcid":true,"given":"Erika Mar\u00eda","family":"Mart\u00ednez-Carre\u00f1o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Pablo","family":"Costabel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7119-7993","authenticated-orcid":true,"given":"Enrique A.","family":"Berrios-B\u00e1rcenas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Barroso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6860-3292","authenticated-orcid":true,"given":"Jos\u00e9 Angel","family":"Cigarroa L\u00f3pez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Ortega Reyes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1130-3799","authenticated-orcid":true,"given":"Jaime","family":"Alvarez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"P\u00e9rez de Arenaza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Buitrago","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8152-9226","authenticated-orcid":true,"given":"Constanza","family":"Otero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudenice","family":"Leite Bertoli de Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Sebasti\u00e1n","family":"Molina G\u00f3mez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3487-2240","authenticated-orcid":true,"given":"Guilherme","family":"Silva Julian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"issue":"4","key":"pone.0351224.ref001","first-page":"512","article-title":"Diagnosis and treatment of cardiac amyloidosis","volume":"23","author":"P Garcia-Pavia","year":"2021","journal-title":"Eur J Heart Fail"},{"issue":"22","key":"pone.0351224.ref002","doi-asserted-by":"crossref","first-page":"2872","DOI":"10.1016\/j.jacc.2019.04.003","article-title":"Transthyretin Amyloid Cardiomyopathy: JACC State-of-the-Art Review","volume":"73","author":"FL Ruberg","year":"2019","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"pone.0351224.ref003","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.medcli.2020.06.064","article-title":"Amiloidosis card\u00edaca por transtiretina","volume":"156","author":"P Garcia-Pavia","year":"2021","journal-title":"Medicina Cl\u00ednica"},{"issue":"10","key":"pone.0351224.ref004","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1016\/j.jchf.2021.05.005","article-title":"Sex-Related Risk of Cardiac Involvement in Hereditary Transthyretin Amyloidosis: Insights From THAOS","volume":"9","author":"AG Caponetti","year":"2021","journal-title":"JACC Heart Fail"},{"issue":"9","key":"pone.0351224.ref005","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1002\/ejhf.2589","article-title":"Prevalence and clinical outcomes of transthyretin amyloidosis: a systematic review and meta-analysis","volume":"24","author":"AS Antonopoulos","year":"2022","journal-title":"Eur J Heart Fail"},{"issue":"4","key":"pone.0351224.ref006","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1007\/s12350-022-03005-5","article-title":"Cardiac amyloidosis in Latin America: Gaps and opportunities to increase awareness of the disease. Findings from the AMILO-LATAM research group","volume":"30","author":"F Mut","year":"2023","journal-title":"J Nucl Cardiol"},{"issue":"2","key":"pone.0351224.ref007","doi-asserted-by":"crossref","first-page":"17","DOI":"10.14797\/mdcvj.1066","article-title":"ATTR Epidemiology, Genetics, and Prognostic Factors","volume":"18","author":"CA Obi","year":"2022","journal-title":"Methodist Debakey Cardiovasc J"},{"issue":"7","key":"pone.0351224.ref008","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1080\/10408363.2024.2350379","article-title":"Transthyretin mutagenesis: impact on amyloidogenesis and disease","volume":"61","author":"ZL Almeida","year":"2024","journal-title":"Crit Rev Clin Lab Sci"},{"issue":"6","key":"pone.0351224.ref009","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s12170-021-00670-y","article-title":"Racial and Ethnic Disparities in Transthyretin Cardiac Amyloidosis","volume":"15","author":"G Spencer-Bonilla","year":"2021","journal-title":"Curr Cardiovasc Risk Rep"},{"key":"pone.0351224.ref010","volume-title":"Transthyretin Amyloid Cardiomyopathy (ATTR-CM). StatPearls. Treasure Island","author":"A Jain","year":"2022"},{"issue":"1","key":"pone.0351224.ref011","first-page":"78","article-title":"Clinical Practice Guidelines for diagnosis of organic involvement of amyloidosis: Part 2\/3.Year 2020","volume":"79","author":"ML Posadas Martinez","year":"2022","journal-title":"Rev Fac Cien Med Univ Nac Cordoba"},{"issue":"6","key":"pone.0351224.ref012","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1002\/ejhf.2198","article-title":"Expert consensus on the monitoring of transthyretin amyloid cardiomyopathy","volume":"23","author":"P Garcia-Pavia","year":"2021","journal-title":"Eur J Heart Fail"},{"issue":"1","key":"pone.0351224.ref013","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s13023-021-01706-7","article-title":"Patient and family experience with transthyretin amyloid cardiomyopathy (ATTR-CM) and polyneuropathy (ATTR-PN) amyloidosis: results of two focus groups","volume":"16","author":"D Rintell","year":"2021","journal-title":"Orphanet J Rare Dis"},{"issue":"11","key":"pone.0351224.ref014","first-page":"1076","article-title":"ACC Expert Consensus Decision Pathway on Comprehensive Multidisciplinary Care for the Patient With Cardiac Amyloidosis: A Report of the American College of Cardiology Solution Set Oversight Committee","volume":"81","author":"MM Kittleson","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"pone.0351224.ref015","first-page":"1","article-title":"Consenso de diagn\u00f3stico y tratamiento de la cardiopat\u00eda amiloid\u00f3tica","volume":"93","author":"J Costabel","year":"2025","journal-title":"Revista Argentina de Cardiolog\u00eda"},{"issue":"11","key":"pone.0351224.ref016","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1001\/jamacardio.2021.3070","article-title":"Prevalence of Transthyretin Amyloid Cardiomyopathy in Heart Failure With Preserved Ejection Fraction","volume":"6","author":"OF AbouEzzeddine","year":"2021","journal-title":"JAMA Cardiol"},{"issue":"2","key":"pone.0351224.ref017","first-page":"19","article-title":"The use of PYP scan for evaluation of ATTR cardiac amyloidosis at a tertiary medical centre","volume":"29","author":"J Dower","year":"2022","journal-title":"Br J Cardiol"},{"issue":"6","key":"pone.0351224.ref018","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1007\/s00415-019-09688-0","article-title":"Expert consensus recommendations to improve diagnosis of ATTR amyloidosis with polyneuropathy","volume":"268","author":"D Adams","year":"2021","journal-title":"J Neurol"},{"issue":"1","key":"pone.0351224.ref019","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.120.008193","article-title":"Long-Term Survival With Tafamidis in Patients With Transthyretin Amyloid Cardiomyopathy","volume":"15","author":"P Elliott","year":"2022","journal-title":"Circ Heart Fail"},{"issue":"3","key":"pone.0351224.ref020","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1002\/ehf2.13913","article-title":"Healthcare resource use of patients with transthyretin amyloid cardiomyopathy","volume":"9","author":"R Lauppe","year":"2022","journal-title":"ESC Heart Fail"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351224","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T17:50:51Z","timestamp":1782496251000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351224"}},"subtitle":[],"editor":[{"given":"Roberto Magalh\u00e3es","family":"Saraiva","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":20,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,26]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0351224","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]}}}