ACC's newest Expert Consensus Decision Pathway released Jan. 23 in JACC provides "practical and timely guidance on the diagnosis and management of cardiac amyloidosis," with an emphasis on comprehensive multidisciplinary care.

The Pathway recognizes the complexity in treating patients with amyloidosis and is organized around three key steps:

1. Identifying what cardiovascular clinicians should know about the diagnosis and management of cardiac amyloidosis and when to consult with a cardiac amyloid specialist.
2. Recognizing the relevant extracardiac manifestations involving the kidney, nervous system, gastrointestinal tract, and musculoskeletal system and how and when to establish multidisciplinary collaborations to manage patient care.
3. Understanding future directions and unanswered questions in the field.

According to the authors, led by Writing Committee Chair Michelle M. Kittleson, MD, PhD, FACC, and Vice Chair Frederick L. Ruberg, MD, FACC, these steps aim to help all cardiovascular clinicians "be aware of the clinical clues that suggest a diagnosis of cardiac amyloidosis" and "be able to identify the diagnostic algorithm for cardiac amyloidosis, including the role of the monoclonal protein screen, bone scintigraphy, and/or genetic testing and/or biopsy." They also note the importance of helping clinicians avoid "diagnostic pitfalls of the monoclonal protein screen, bone scintigraphy, and biopsy" and improving understanding of how to "implement a treatment plan with specific attention to the roles of traditional [heart failure] medications and arrhythmia management."

Looking to the future, the Pathway highlights some of the barriers to equitable care in cardiac amyloidosis, including the high cost of medications, the complexity of prior approval processes, variation in out-of-pocket expenses, and limited access to regional specialists – topics that the ACC continues to prioritize working with industry, payers, members of Congress and other key stakeholders. The authors suggest that telehealth with appropriate insurance coverage and giving clinicians the ability to practice across state lines may help to mitigate some of these barriers.

"The treatment of patients with amyloidosis is complex. It involves physicians and advanced-practice providers across a wide array of specialties, including primary care, cardiology, nephrology, hematology, neurology, gastroenterology, and palliative care," the authors write. "It also involves associated providers such as nurses, pharmacists, dieticians, and geneticists. We anticipate that the algorithms proposed here will continue to evolve as new evidence emerges but that the overarching and now attainable goal of improving cardiovascular outcomes in patients with cardiac amyloidosis will remain consistent.

Access key points to remember from the document, here.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Nuclear Imaging, Cardio-Oncology

Keywords: Pharmacists, Prior Authorization, Health Expenditures, Amyloidosis, Heart Failure, Amyloid, Telemedicine, Radionuclide Imaging, Arrhythmias, Cardiac, Nurses

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