Cardiologist KMH Cardiology and Diagnostic Centres, Canada
Background: Transthyretin Amyloid Cardiomyopathy (ATTR-CM) is a serious and often underdiagnosed condition where the transthyretin protein misfolds and forms amyloid fibrils. These fibrils accumulate in the heart, causing the walls to stiffen, impairing the heart's ability to pump blood effectively. Diagnosing ATTR-CM can be quite challenging due to several factors: Non-specific symptoms, lack of awareness, complex diagnostic process and overlap with other conditions.
EQUIP aims to reduce the time it takes to diagnose ATTR-CM by integrating guideline-based prompts into the CEREBRUM electronic medical record (EMR). The goal is to make guideline-based medicine more accessible and efficient, preventing patients from being overlooked in the diagnostic process.
METHODS AND RESULTS: The project focuses on three specific prompts targeting 3 key stages in the diagnostic process:
1. GLS Calculation: Prompts for echocardiogram technicians to perform global longitudinal strain (GLS) calculations when indicated, aiming to increase the measurement rate of this important metric for further ATTR-CM diagnostics. 2. Patient History: Prompts to doctors (or their teams) to collect relevant patient history information, which may be used as a condition for prompt 3. 3. External Referral: Prompts to remind physicians to refer patients for additional testing to confirm ATTR-CM when clinical criteria are met.
The project tracks technologists and physicians’ responses to these prompts to measure effectiveness.
During the period of Mar 2024-Feb 2025 when the prompts were fully implemented, the echocardiogram technologists’ response to the prompts resulted in the 12-month average GLS calculated of all patients with echocardiogram appointments increasing 12-fold (0.23% to 2.9%) after the introduction of the prompts. During the same period, 72% of echocardiograms that received prompts had the GLS measurement calculated. In addition, the introduction of referral prompts increased the 12-month average of referral rates (# of referrals by total consultations) 6.4 fold (0.035% to 0.23%). Of the consults that received a referral prompt, 13.6% resulted in physicians sending referrals for PYP scans/amyloid consultations.
Conclusion: The project demonstrates a proactive approach to improving diagnostic pathways through technological integration. The focus on measurable metrics allows for ongoing evaluation and refinement of the EMR prompts. The EMR prompts provide a strategy for driving guideline adherence. The success of this project could provide a model for similar quality improvement initiatives for other diseases.
