The diagnosis of transthyretin cardiac amyloidosis (ATTR-CM) is complex. Diagnostic includes numerous examinations and implicates diverse medical specialists.

The objective of the DIAM-ATTR survey was to obtain a snapshot of the current ATTR-CM diagnostic pathway in France.

An electronic survey was sent to almost 70% of the 20.067 French healthcare professionals (HCPs) potentially implicated in ATTR-CM diagnosis and representing both public and private practice throughout France. The “Réseau Amylose” and Cardiogen networks were implicated in developing and distributing the survey. The survey collected data concerning HCPs’ levels of knowledge on ATTR-CM (particularly signs and symptoms), use of the recommended diagnostic algorithm, the diagnostic pathway, as well as the difficulties encountered during diagnosis, overall and according to each specialty.

In total, 1264 physicians answered the survey (471 cardiologists, 186 internists, 148 nuclear medicine physicians, 125 geriatricians, 120 orthopaedic surgeons, 112 neurologists, and 102 rheumatologists). The levels of knowledge with respect to the signs and symptoms suggesting ATTR-CM differed between HCPs according to specialty, see Fig. 1. Regarding the diagnostic pathway, among the 719 HCPs diagnosing ATTR-CM, most adhere to the current diagnostic algorithm with almost all respondents performing bone scintigraphy and monoclonal gammopathy. However, some diagnostic examinations such as genetic testing were not systematically performed (36% to 93% depending on specialty). The healthcare pathway (including numbers of patients seen with suspected ATTR-CM, referral patterns, numbers and order of examinations performed), as well as difficulties encountered for ATTR-CM diagnosis varied among specialists. The predominant difficulty pertained to confirming the type of amyloidosis by biopsy.

The French DIAM-ATTR survey shows that in a large cohort of HCPs, the recommended diagnostic algorithm for ATTR-CM is mostly followed although further HCPs education on clinical signs associated with ATTR-CM is needed. The survey identified several difficulties in the diagnostic pathway of the disease that should be overcome to improve ATTR-CM patients management.