Clinical Outcomes and Health Care Costs in Patients Hospitalized With Heart Failure and Transthyretin Amyloid Cardiomyopathy: Findings From GWTG-HF.

BACKGROUND: The real-world clinical and economic burden of transthyretin amyloid cardiomyopathy (ATTR-CM) is not well characterized. Prior studies have often been limited by uncertain generalizability or reliance on administrative claims data, which can lack diagnostic accuracy. This study aimed to evaluate outcomes and costs in a large, nationally representative US cohort with clinically recognized ATTR-CM. METHODS: Among patients hospitalized for heart failure (HF) in the Get With The Guidelines-Heart Failure (GWTG-HF) registry between 2021 and 2024, clinical characteristics and in-hospital mortality were compared by ATTR-CM status, as documented in the registry case report form. In the subset of Medicare beneficiaries, 1-year postdischarge outcomes (all-cause mortality, HF readmission, and all-cause readmission) and per-patient health care costs (total, inpatient, and outpatient, excluding Part D medication costs in 2024 $USD) were assessed. RESULTS: Among 550,236 patients hospitalized for HF across 613 hospitals, 1151 (0.2%) had ATTR-CM. Compared to patients with HF without ATTR-CM, those with HF and ATTR-CM were older (median age 79 vs 72 years), more often men (68.5% vs 53.2%), and more frequently prescribed mineralocorticoid-receptor antagonists (33.8% vs 26.4%) and sodium-glucose cotransporter 2 inhibitors (29.6% vs 19.5%) at discharge. After adjustment, ATTR-CM was not associated with in-hospital mortality (adjusted odds ratio 1.18, 95% CI, 0.87-1.60) or length of stay (adjusted ratio of medians 1.04, 95% CI, 0.99-1.10). Over 1-year postdischarge, ATTR-CM was independently associated with a higher risk of HF readmission (36.8% vs 28.2%; adjusted hazard ratio [HR] 1.28, 95% CI, 1.01-1.61), but not all-cause mortality (40.0% vs 34.2%; adjusted HR 1.08, 95% CI, 0.88-1.31) or all-cause readmission (64.2% vs 63.4%; adjusted HR 0.98, 95% CI, 0.83-1.17). One-year total per-patient Medicare costs were higher among patients with HF and ATTR-CM (mean $60,373; 95% CI, $48,151-$72,595 vs mean $50,247; 95% CI, $49,813-$50,681), primarily driven by greater outpatient costs (mean $20,866; 95% CI, $16,703-$25,029 vs mean $16,358; 95% CI, $16,201-$16,515). CONCLUSIONS: Among patients hospitalized for HF, after adjustment for potential confounders, those with ATTR-CM experienced higher risks of HF readmission and incurred greater health care costs but did not have significantly different risks of in-hospital or postdischarge mortality.

Duke Scholars

Author Senthil Selvaraj Medicine, Cardiology

Author Michel Georges Khouri Medicine, Cardiology

Author Stephen Greene Medicine, Cardiology