Discoveries in Heart Failure

Discoveries in Heart Failure

Source:

Cavalier JS, et al. P1868. Presented at: American Heart Association Scientific Sessions; Nov. 13-15, 2021 (virtual meeting).

Disclosures: Cavalier reports no relevant financial disclosures.
November 30, 2021
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EHR data reveal ‘red flag’ comorbidities years before cardiac amyloidosis diagnosis

Source:

Cavalier JS, et al. P1868. Presented at: American Heart Association Scientific Sessions; Nov. 13-15, 2021 (virtual meeting).

Disclosures: Cavalier reports no relevant financial disclosures.
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Common “red flag” comorbid conditions stored in the electronic health record often preceded the diagnosis of cardiac amyloidosis by years, according to a presentation from the American Heart Association Scientific Sessions.

“Now that there are disease-modifying therapies on the market, there’s new impetus for improved awareness, screening and diagnosis of this condition,” Joanna S. Cavalier, MD, of Duke University Medical Center, said during the presentation. “Given the vast amount of data available via the electronic health record, we should be able to find this diagnosis earlier and get these patients to treatment sooner.”

Cavalier and colleagues used automated extraction of clinical data stored EHR at a single institution to determine the prevalence and associations of “red flag” comorbid conditions to a cardiac amyloidosis diagnosis. The researchers identified patients with light-chain (AL) and transthyretin (ATTR) cardiac amyloidosis. Using the EHR, they extracted dates of the diagnoses of red flag comorbid conditions and cardiac amyloidosis, then examined frequency and time between the diagnoses the two.

Of 175 patients with cardiac amyloidosis (85% ATTR), 89.1% of patients had a diagnosis code for amyloidosis and 84.6% had a HF diagnosis. The results showed that red flag comorbid conditions were more likely to have been diagnosed before cardiac amyloidosis than after.

Cavalier reported that, on average, the red flag comorbidity carpal tunnel syndrome was diagnosed 8.3 years before a diagnosis of cardiac amyloidosis. In addition, the average intervals between diagnoses was 5.9 years for spinal stenosis, 2.8 years for atrial fibrillation and 2.4 years for HF.

“We therefore conclude that data from the electronic health record can be used to identify red flag comorbidities and, now that there are disease-modifying therapies for cardiac amyloidosis, we need screening protocols. These screening protocols can use red flags, which are extremely common and typically appear years — as we saw 6 or even 8 years — before a diagnosis of cardiac amyloidosis,” Cavalier said. “In using this protocol, we can diagnose patients sooner and get them onto disease-modifying therapies, which are more effective when diagnosed earlier in disease.”