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. 2022 Jun;9(3):1636-1642.
doi: 10.1002/ehf2.13913. Epub 2022 Apr 1.

Healthcare resource use of patients with transthyretin amyloid cardiomyopathy

Rosa Lauppe  1 , Johan Liseth Hansen  1   2 , Anna Fornwall  1 , Katarina Johansson  3 , Mark H Rozenbaum  4 , Anne Mette Strand  5 , Merja Vakevainen  6 , Johanna Kuusisto  7 , Einar Gude  8 , J Gustav Smith  9   10 , Finn Gustafsson  11
Affiliations

Healthcare resource use of patients with transthyretin amyloid cardiomyopathy

Rosa Lauppe et al. ESC Heart Fail. 2022 Jun.

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.

Keywords: Burden; Cardiomyopathy; Healthcare resource use; Heart failure; TTR amyloidosis.

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Conflict of interest statement

R.L., J.L.H., and A.F. are employed by Quantify Research and funded by Pfizer to conduct this study; Quantify Research is a consultancy and works with a range of different pharmaceutical companies. K.J., M.H.R., A.M.S., and M.V. are Pfizer employees and hold Pfizer stock and/or stock options. J.K. received support from Pfizer for her collaboration in this manuscript as well as grants or contracts from Sanofi‐Genzyme, Pfizer, and The Finnish Foundation for Cardiovascular Research. J.K. also received consulting fees and honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Sanofi‐Genzyme, Pfizer, Bayer, Takeda, Amgen, and Chiesi as well as payment for expert testimony from Sanofi‐Genzyme, Pfizer, Bayer, Takeda, and Amgen. J.K. has received support for participation on a Data Safety Monitoring Board or Advisory Board from Sanofi‐Genzyme, Pfizer, Bayer, Takeda, Amgen, and Chiesi and is supported by Amgen for Leadership or fiduciary role in other board, society, committee, or advocacy group. E.G. has received grants and honoraria for lectures from Pfizer. F.G. has received support from Pfizer for work on the present manuscript and consulting fees from Pfizer, Alnylam, and Ionis. J.G.S. has no conflict of interests.

Figures

Figure 1
Figure 1
The mean number of outpatient visits, hospitalizations and hospitalization days in the years before diagnosis (Years 3 to 1) and year directly following and including diagnosis (Year 0). The dotted lines represent the mean number for the entire pre‐diagnosis period. The error bars represent 95% confidence intervals. ATTR‐CM, transthyretin amyloid cardiomyopathy; HF, heart failure.
Figure 2
Figure 2
Share of patients with at least one and three or more outpatient visits/hospitalizations in the three years before diagnosis (Years 3 to 1). The error bars indicate 95% confidence intervals. ATTR‐CM, transthyretin amyloid ardiomyopathy; HF, heart failure.
Figure 3
Figure 3
The mean number of outpatient visits, hospitalizations, hospitalizations days, and surgeries in 2018. The error bars indicate 95% confidence intervals. ATTR‐CM, transthyretin amyloid cardiomyopathy; HF, heart failure.
See this image and copyright information in PMC

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