{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T02:13:24Z","timestamp":1793844804561,"version":"4.6.1"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Most patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) are diagnosed noninvasively, using nuclear imaging and monoclonal protein testing. However, concerns have been raised that some may receive an ATTRwt-CM diagnosis based on incomplete evaluations (not based on current consensus recommendations). Using a cohort of US Medicare Fee-for-Service patients, we aimed to examine the frequency and cadence of diagnostic testing for ATTRwt-CM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective observational cross-sectional study, administrative de-identified claims data from 2018 to 2022 were derived from patients aged \u226565 years who had at least one claim for ATTRwt-CM and heart failure or cardiomyopathy, and \u22652 years of continuous Medicare enrollment before the first ATTRwt-CM diagnosis. Patients with claims for any other form of amyloidosis, multiple myeloma, or plasma cell dyscrasias were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 2,050 patients with ATTRwt-CM, mean (SD) age was 80.0 (6.9) years, and 75.5% were men. Annual new ATTRwt-CM diagnoses nearly tripled over the study period (2018,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009198; 2022,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009578). Technetium-99m pyrophosphate (PYP) scintigraphy use was performed in approximately half of diagnosed patients by the end of the study period (2018, 30%; 2022, 49%). Cardiac biopsy use declined from 14% in patients diagnosed in 2018 to 5% in those diagnosed in 2022. A small minority (14%) of patients underwent the recommended noninvasive diagnostic testing comprised of PYP scintigraphy and complete monoclonal protein testing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Based on Medicare claims data, most patients diagnosed with ATTRwt-CM have not been diagnosed following consensus-recommended pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2025.1638380","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T12:48:19Z","timestamp":1761742099000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Trends in diagnostic testing in Medicare patients with wild-type transthyretin amyloid cardiomyopathy"],"prefix":"10.3389","volume":"12","author":[{"given":"Ronald M.","family":"Witteles","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haechung","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Dai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Gutierrez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Rava","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameer","family":"Swarup","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbas","family":"Ebrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindi","family":"Pankratova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1076","DOI":"10.1016\/j.jacc.2022.11.022","article-title":"2023 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":"Kittleson","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1080\/13506129.2020.1835263","article-title":"Amyloid nomenclature 2020: update and recommendations by the international society of amyloidosis (ISA) nomenclature committee","volume":"27","author":"Benson","year":"2020","journal-title":"Amyloid"},{"key":"B3","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1007\/s10741-021-10080-2","article-title":"Screening for ATTR amyloidosis in the clinic: overlapping disorders, misdiagnosis, and multiorgan awareness","volume":"27","author":"Nativi-Nicolau","year":"2022","journal-title":"Heart Fail Rev"},{"key":"B4","doi-asserted-by":"publisher","first-page":"P22","DOI":"10.1186\/1750-1172-10-S1-P22","article-title":"Patient experience with hereditary and senile systemic amyloidoses: a survey from the amyloid research consortium","volume":"10","author":"Lousada","year":"2015","journal-title":"Orphanet J Rare Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1016\/j.jchf.2019.04.010","article-title":"Screening for transthyretin amyloid cardiomyopathy in everyday practice","volume":"7","author":"Witteles","year":"2019","journal-title":"JACC Heart Fail"},{"key":"B6","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1007\/s40119-021-00219-5","article-title":"Impact of delayed diagnosis and misdiagnosis for patients with transthyretin amyloid cardiomyopathy (ATTR-CM): a targeted literature review","volume":"10","author":"Rozenbaum","year":"2021","journal-title":"Cardiol Ther"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2404","DOI":"10.1161\/circulationaha.116.021612","article-title":"Nonbiopsy diagnosis of cardiac transthyretin amyloidosis","volume":"133","author":"Gillmore","year":"2016","journal-title":"Circulation"},{"key":"B8","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.jaccao.2019.08.002","article-title":"AL Amyloidosis for the cardiologist and oncologist: epidemiology, diagnosis, and management","volume":"1","author":"Witteles","year":"2019","journal-title":"J Am Coll Cardiol CardioOncol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"2851","DOI":"10.1016\/j.jacc.2020.04.022","article-title":"Cardiac scintigraphy with technetium-99m-labeled bone-seeking tracers for suspected amyloidosis: JACC review topic of the week","volume":"75","author":"Hanna","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1093\/ehjci\/jeab095","article-title":"99mTc-DPD Scintigraphy in immunoglobulin light chain (AL) cardiac amyloidosis","volume":"22","author":"Quarta","year":"2021","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"B11","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1016\/j.mayocp.2018.08.006","article-title":"A modern primer on light chain amyloidosis in 592 patients with mass spectrometry-verified typing","volume":"94","author":"Muchtar","year":"2019","journal-title":"Mayo Clin Proc"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e7","DOI":"10.1161\/cir.0000000000000792","article-title":"Cardiac amyloidosis: evolving diagnosis and management: a scientific statement from the American Heart Association","volume":"142","author":"Kittleson","year":"2020","journal-title":"Circulation"},{"key":"B13","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1373\/clinchem.2004.046870","article-title":"Diagnostic performance of quantitative \u03ba and \u03bb free light chain assays in clinical practice","volume":"51","author":"Katzmann","year":"2005","journal-title":"Clin Chem"},{"key":"B14","doi-asserted-by":"publisher","first-page":"609","DOI":"10.31662\/jmaj.2024-0357","article-title":"Periorbital Purpura as a key diagnostic clue in immunoglobulin light chain amyloidosis","volume":"8","author":"Miyaue","year":"2025","journal-title":"JMA J"},{"key":"B15","doi-asserted-by":"publisher","first-page":"5946","DOI":"10.12998\/wjcc.v12.i26.5946","article-title":"Periorbital purpura can be the only initial symptom of primary light chain amyloidosis: a case report","volume":"12","author":"Wang","year":"2024","journal-title":"World J Clin Cases"},{"key":"B16","doi-asserted-by":"publisher","first-page":"ytad108","DOI":"10.1093\/ehjcr\/ytad108","article-title":"Hereditary transthyretin amyloidosis presenting with spontaneous periorbital purpura: a case report","volume":"7","author":"Jhawar","year":"2023","journal-title":"Eur Heart J Case Rep"},{"key":"B17","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.amjcard.2021.11.048","article-title":"Temporal trends in diagnostic testing patterns for wild-type transthyretin amyloid cardiomyopathy in the medicare fee-for-service population","volume":"167","author":"Bourque","year":"2022","journal-title":"Am J Cardiol"},{"key":"B18","article-title":"Guidelines for Good Pharmacoepidemiology Practices (GPP). (2015)","year":""},{"key":"B19","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1046\/j.1524-4733.2003.00242.x","article-title":"A checklist for retrospective database studies\u2014report of the ISPOR task force on retrospective databases","volume":"6","author":"Motheral","year":"2003","journal-title":"Value Health"},{"key":"B20","first-page":"467","article-title":"GRACE Principles: recognizing high-quality observational studies of comparative effectiveness","volume":"16","author":"Dreyer","year":"2010","journal-title":"Am J Manag Care"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1638380\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T12:48:19Z","timestamp":1761742099000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1638380\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,29]]},"references-count":20,"alternative-id":["10.3389\/fcvm.2025.1638380"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1638380","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,29]]},"article-number":"1638380"}}