Background: Transthyretin amyloidosis (ATTR) is an underdiagnosed cause of cardiomyopathy that is gaining recognition as new treatments become available. The prevalence of wild-type ATTR cardiomyopathy may be higher in veterans. Initial ATTR diagnosis can be missed if there is a low clinical index of suspicion; however, identification of early red-flag signs may lead to earlier diagnosis and reduce morbidity and mortality.
Case Presentations: This case series describes 8 patients diagnosed with ATTR at the Veterans Affairs New York Harbor Healthcare System-Brooklyn. All patients were male, with a mean age of 79 years at diagnosis. Seven patients were diagnosed with heart failure and arrhythmias (most commonly atrial fibrillation), 4 had syncope, and 2 had spinal stenosis. Despite being treated with tafamidis, some patients had recurrent hospitalizations and eventually died.
Conclusions: These cases illustrate the early signs of ATTR present. The implementation of a screening program for patients with specific risk factors may help identify individuals with this disease, leading to earlier treatment initiation and improved outcomes. Primary care clinicians should be aware of these early signs to ensure prompt referral to cardiology.