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Ponti L, Hsu K, Damy T, Villacorta E, Verheyen N, Keohane D, Wang R, Ines M, Kumar N, Munteanu C, Cappelli F. Burden of untreated transthyretin amyloid cardiomyopathy on patients and their caregivers by disease severity: results from a multicenter, non-interventional, real-world study. Front Cardiovasc Med 2023; 10:1238843. [PMID: 37711563 PMCID: PMC10497948 DOI: 10.3389/fcvm.2023.1238843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/27/2023] [Indexed: 09/16/2023] Open
Abstract
Background The humanistic burden of transthyretin amyloid cardiomyopathy (ATTR-CM) is poorly defined. Methods An international study to comprehensively characterize the burden of ATTR-CM on patients naïve to disease-modifying therapy and their unpaid primary caregivers using study-specific and established surveys (patients: Kansas City Cardiomyopathy Questionnaire Overall Summary [KCCQ-OS], 12-Item Short Form Health Survey [SF-12], Hospital Anxiety and Depression Scale [HADS], Patient-Reported Outcomes Measurement Information System [PROMIS] Fatigue and Dyspnea; caregivers: SF-12, HADS, PROMIS Fatigue, Zarit Burden Interview [ZBI]). All data were summarized descriptively. Results 208 patient and caregiver pairs were included. 86% of patients were male, median age was 81 years, and 91% (141/155 with genetic testing) had wild-type ATTR-CM. Patient responses characterized the mental and physical burden of ATTR-CM, which was numerically higher among those who were New York Heart Association (NYHA) class III (n = 43) vs. class I/II (n = 156). NYHA class III patients had particularly low KCCQ-OS (36) and SF-12 physical component (27) scores, and 67% had a HADS depression score ≥8. Caregivers (median age 68 years; 85% female; 59% spouse of the patient; median duration of caregiving 1.5 years) reported that NYHA III patients more frequently required help with a range of physical activities than NYHA class I/II patients. 51% of caregivers to NYHA class III patients reported at least a mild-to-moderate burden in the ZBI. A plain language summary of this paper can be found as a supplemental material. Conclusions Untreated ATTR-CM is a burden to both patients and their caregivers.
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Affiliation(s)
- Lucia Ponti
- University of Urbino Carlo Bo, Urbino, Italy
| | - Kristen Hsu
- Amyloidosis Research Consortium, Newton, MA, United States
| | - Thibaud Damy
- Referral Center for Cardiac Amyloidosis, CHU Henri Mondor, Créteil, France
| | | | | | | | | | | | | | | | - Francesco Cappelli
- Tuscan Regional Amyloidosis Referral Centre, Careggi University Hospital, Florence, Italy
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Nativi-Nicolau J, Fine NM, Ortiz-Pérez JT, Brown D, Vera-Llonch M, Reddy SR, Chang E, Tarbox MH. Clinical manifestations and healthcare utilization before diagnosis of transthyretin amyloidosis. J Comp Eff Res 2022; 11:1031-1044. [PMID: 35993313 DOI: 10.2217/cer-2022-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Initial clinical manifestations of transthyretin amyloidosis (ATTR) are not well understood, making timely diagnosis challenging. Methods: Patients aged ≥68 years newly diagnosed with ATTR were identified using Medicare Research Identifiable Files. Symptom manifestation and healthcare utilization were measured during 3 years pre-diagnosis; demographics and comorbidity index during 1-year pre-diagnosis. Controls (ATTR-free) were matched 1:1 to patients with ATTR based on age, sex and region; same index date and enrollment as match. Results: We identified 552 matched ATTR-control pairs: mean age 78.3 (standard deviation 6.3) and 64.5% male. Among patients with ATTR (vs controls), cardiovascular conditions (92.9 vs 75.9%) and hospitalization (54.0 vs 35.5%) were frequent during 3 years pre-diagnosis. Conclusion: Patients with ATTR have multiple symptoms and hospitalizations pre-diagnosis, recognition of which may facilitate earlier diagnosis and treatment.
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Affiliation(s)
| | | | - José Thomás Ortiz-Pérez
- Amyloidosis & Myeloma Unit, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Villarroel 170, Barcelona, 08036, Spain
| | - Duncan Brown
- Ionis Pharmaceuticals, Inc., One Beacon Street, Boston, MA 02108, USA
| | | | - Sheila R Reddy
- PHAR (Partnership for Health Analytic Research), Beverly Hills, CA 90212, USA
| | - Eunice Chang
- PHAR (Partnership for Health Analytic Research), Beverly Hills, CA 90212, USA
| | - Marian H Tarbox
- PHAR (Partnership for Health Analytic Research), Beverly Hills, CA 90212, USA
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Clinical manifestation, economic burden, and mortality in patients with transthyretin cardiac amyloidosis. Orphanet J Rare Dis 2022; 17:262. [PMID: 35840997 PMCID: PMC9287852 DOI: 10.1186/s13023-022-02425-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
Background Transthyretin cardiac amyloidosis, also known as transthyretin cardiomyopathy (ATTR-CM) is a poorly-recognized disease with delayed diagnosis and poor prognosis. This nationwide population-based study aimed to identify disease manifestations, economic burden, and mortality of patients with ATTR-CM. Methods Data of newly diagnosed patients with ATTR-CM between 2013 and 2018 from the Korean National Health Insurance Service were used, covering the entire population. Patient characteristics included comorbidities, medical procedures, and medication. Healthcare resource utilization and medical costs were observed as measures of the economic burden. The Kaplan–Meier survival curve and years of potential life lost (YPLL) from the general population were estimated for disease burden with ATTR CM. Results A total of 175 newly diagnosed patients with ATTR-CM were identified. The most common cardiac manifestation was hypertension (51.3%), while the most common non-cardiac manifestation was musculoskeletal disease (68.0%). Mean medical costs at the post-cohort entry date were significantly higher than those at the pre-cohort entry date ($1,864 vs. $400 per patient per month (PPPM), p < 0.001). Of the total medical costs during the study period, the proportion of inpatients cost was 12.9 times higher than the outpatients cost ($1,730 and $134 PPPM, respectively). The median survival time was 3.53 years from the first diagnosis of ATTR-CM, and the mean (SD) YPLL was 13.0 (7.7). Conclusions Patients with ATTR-CM had short survival and high medical costs. To reduce the clinical and economic burdens, carefully examining manifestations of disease in patients can help with early diagnosis and treatment.
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Lauppe R, Liseth Hansen J, Fornwall A, Johansson K, Rozenbaum MH, Strand AM, Vakevainen M, Kuusisto J, Gude E, Smith JG, Gustafsson F. Healthcare resource use of patients with transthyretin amyloid cardiomyopathy. ESC Heart Fail 2022; 9:1636-1642. [PMID: 35365974 PMCID: PMC9065857 DOI: 10.1002/ehf2.13913] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/01/2022] [Accepted: 03/11/2022] [Indexed: 11/27/2022] Open
Abstract
Aims Transthyretin amyloid cardiomyopathy (ATTR‐CM) is the cardiac manifestation of transthyretin amyloidosis (ATTR). The aim of this study was to estimate healthcare resource use for ATTR‐CM patients compared with heart failure (HF) patients, in Denmark, Finland, Norway, and Sweden. Methods and results Data from nationwide healthcare registers in the four countries were used. ATTR‐CM patients were defined as individuals diagnosed with amyloidosis and cardiomyopathy or HF between 2008 and 2018. Patients in the ATTR‐CM cohort were matched to patients with HF but without ATTR‐CM diagnosis. Resource use included number of visits to specialty outpatient and inpatient hospital care. A total of 1831 ATTR‐CM and 1831 HF patients were included in the analysis. The mean number of hospital‐based healthcare contacts increased in both the ATTR‐CM and HF cohort during 3 years pre‐diagnosis and was consistently higher for the ATTR‐CM cohort compared with the HF cohort, with 6.1 [CI: 5.9–6.3] vs. 3.2 [CI: 3.1–3.3] outpatient visits and 1.03 [CI: 0.96–1.1] vs. 0.7 [CI: 0.7–0.8] hospitalizations. In the first year following diagnosis, patients with ATTR‐CM continued to visit outpatient care (10.2 [CI: 10.1, 10.4] vs. 5.7 [CI: 5.6, 5.9]) and were admitted to hospital more frequently (3.3 [CI: 3.2, 3.4] vs. 2.5 [CI: 2.5, 2.6]) than HF patients. Conclusions Transthyretin amyloid cardiomyopathy imposes a high burden on healthcare systems with twice as many outpatient specialist visits and 50% more hospitalizations in the year after diagnosis compared with HF patients without ATTR‐CM. Studies to investigate if earlier diagnosis and treatment of ATTR‐CM may lower resource use are warranted.
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Affiliation(s)
- Rosa Lauppe
- Quantify Research AB, Stockholm, 112 21, Sweden
| | - Johan Liseth Hansen
- Quantify Research AB, Stockholm, 112 21, Sweden.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | | | - Johanna Kuusisto
- Department of Medicine and Clinical Research, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - J Gustav Smith
- Department of Cardiology, Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden.,The Wallenberg Laboratory/Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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Damy T, Conceição I, García-Pavía P, Gillmore J, Jandhyala R, Sabbat J, Wixner J, Coelho T. A simple core dataset and disease severity score for hereditary transthyretin (ATTRv) amyloidosis. Amyloid 2021; 28:189-198. [PMID: 34042016 DOI: 10.1080/13506129.2021.1931099] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hereditary transthyretin (ATTRv) amyloidosis is a progressive multisystemic disease of adult-onset that arises from an inherited mutation in the transthyretin gene. Currently available disease severity and progression evaluation tools only cover one single organ or system, impacting data collection uniformity and its use in clinical settings. METHODS The Jandhyala Method, including a systematic literature review and SMART interviews, was used to observe expert opinion from eight leaders in the treatment of ATTRv across Europe. The aim was to propose a multidisciplinary core dataset (CD) and disease severity scoring (DSS) tools. RESULTS The multidisciplinary team of experts identified 140 indicators that form part of the standard diagnostic and monitoring practice (SDMP) and should be collected as the ATTRv CD. Thirty-one (22%) of these indicators informed disease severity and comprised the ATTRv DSS, whilst 25 (18%) were deemed to monitor disease progression. CONCLUSIONS The resulting CD and DSS have different purposes. The ATTRv CD supports the collection of high-quality data for clinical research, whereas the ATTRv DSS can be rapidly conducted in a clinical setting and aid patient management.
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Affiliation(s)
- Thibaud Damy
- Department of Cardiology, Referral Center for Cardiac Amyloidosis, GRC Amyloid Research Institute, DHU A-TVB, APHP CHU Henri Mondor and Université Paris Est Créteil, Créteil, France
| | - Isabel Conceição
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Department of Neurosciences and Mental Health, CHULN-Hospital de Santa Maria, CHULN, Hospital de Santa Maria, Lisboa, Portugal
| | - Pablo García-Pavía
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain.,Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcon, Spain
| | - Julian Gillmore
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Ravi Jandhyala
- Medialis Ltd., Banbury, UK.,Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, Faculty of Life Science & Medicine, King's College University, London, UK
| | | | - Jonas Wixner
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Teresa Coelho
- Andrade's Center for Familial Amyloidosis, Porto, Portugal.,Department of Neurosciences, Hospital de Santo António, Porto, Portugal
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