Socioeconomic Deprivation And The Severity Of Newly Diagnosed Transthyretin Cardiac Amyloidosis: Is There A Link?

Introduction

Cardiac amyloidosis is associated with significant morbidity and mortality, and early diagnosis is crucial to improve survival. Despite advancements in diagnosis and treatment, disparities in disease detection persist in many regions. We sought to explore the impact of social determinants of health (SDoH) on timely diagnosis of transthyretin cardiac amyloidosis (ATTR-CM).

Hypothesis

Patients from neighborhoods with high social deprivation are diagnosed with ATTR-CM at later-stages compared to those presenting from less deprived areas.

Methods

The study cohort included 379 patients referred to the Stanford Amyloid Center for cardiac evaluation from 2009 to 2023. The Columbia staging system was used to classify patients into early, intermediate, and late ATTR-CM disease stages. The score incorporated the National Amyloidosis Center (NAC) staging (NT-proBNP + eGFR), daily furosemide dose equivalents, and NYHA functional class. To quantify SDoH, the neighborhood social deprivation index (SDI) score was tabulated from patients' residential zip-codes (Figure 1). A high SDI, meaning high social deprivation, corresponded to >80th percentile of the SDI scores distribution. Ordinal regression analysis was performed to assess the relationship between high SDI and ATTR-CM Columbia stage at the time of diagnosis.

Results

The mean age was 76±9, 88% were males, and 73% were White. The distribution across early, intermediate and late Columbia stages was 41.2%, 46.7%, and 11.6% of the population, respectively. After adjusting for demographic factors (age, sex, and race), patients from neighborhoods with high SDI were associated with higher Columbia stage [OR 2.03; p<0.01] compared to patients from lower SDI status (Table 1). Notably, Black individuals were also more likely to present with more advanced ATTR-CM [OR 3.36; p<0.01] relative to White individuals. In the adjusted SDI subcomponents analysis, neighborhoods with high poverty had higher odds of having advanced disease at diagnosis [OR 1.69; 95%CI 1.03-2.78; p=0.038].

Conclusion

SDoH appear to be related to delayed diagnosis among individuals with ATTR-CM. Public health interventions are essential to identify and effectively manage ATTR-CM in the most vulnerable communities.