(P155) COMBINED ECHOCARDIOGRAPHER' AND CLINICANS' EDUCATION LEADS TO MORE PROMPT SUSPICION DIAGNOSIS AND TREATMENT OF PATIENTS WITH ATTR CARDIAC AMYLOIDOSIS; A MULTI-FACETED QUALITY IMPROVEMENT INITIATIVE

Background: ATTR Cardiac Amyloidosis (ATTR-CM) is an underdiagnosed cause of heart failure with preserved ejection fraction, with some patients waiting up to 7 years and >2 cardiologist visits before diagnosis. Transthoracic echocardiography (TTE) is the cardiac imaging modality used to raise suspicion for ATTR-CM; yet it must be followed by pyrophosphate scan (PYP) for confirmation. Unfortunately, our center, like many others, struggles with delays in the suspicion, diagnosis and treatment initiation. Our quality improvement (QI) project will map the ATTR-CM journey through our system to identify roadblocks, with the goal of integrating interventions to improve patient outcomes. We implemented a traditional Plan-Do-Study-Act (PDSA) cycle.

METHODS AND RESULTS: This QI initiative retrospectively reviewed all patients with suspected ATTR-CM at our institution who underwent PYP scans from April 1st, 2022, to May 1st, 2024. To reflect the efficiency of amyloid detection, diagnosis, and management at our institution we collected performance indicators including; 1) number of TTEs performed before ATTR-CM suspicion was raised (TTEs obtained within 5 years of diagnosis), and 2) time between TTE suggesting amyloidosis and PYP scan. Process measures included the number of teaching events held during the educational intervention. Finally, two balancing measures were collected; 1) number of PYP scans/month (resource utilization) and, 2) rate of negative PYP scans (as a surrogate for accuracy of amyloid suspicion).

Of the 70 patients included, 33 had a confirmed ATTR-CM. Pre-intervention, an average of 2.4 PYP scans occurred per month with a rate of 48% of those scans being negative. After the intervention, which included; 1) 7 educational sessions on ECHO features of amyloidosis, 2) streamlining of PYP scans to peripheral hospitals, and 3) collaborating with other specialties to expedite AL amyloidosis work ups, the number of PYP scans increased to 3.8 per month with 57% being negative. Pre-intervention, patients underwent an average of 1.9 (SD=1.9) ECHOs within 5 years of the suggestive TTE, which decreased to 1.5 (SD=1.4) post-intervention (p=0.6). Furthermore, TTE-to-PYP time decreased from 7.9 (SD=7.5) to 1.6 (SD=1.8) months (p <.001).

Conclusion: This multi-faceted intervention aimed at physician education and diagnostic streamlining at an institutional level demonstrated a tendency to improve the efficiency of amyloid diagnosis; however, this was associated with a heightened awareness for the disease reflected by high negative PYP scan rates. This highlights the need for continued education efforts, increased support during amyloid work-up, and exploring avenues for continuous quality assurance.