P156 - IMPACT OF A MULTIFACETED QUALITY IMPROVEMENT INITIATIVE ON ACCELERATING DETECTION, DIAGNOSIS, AND MANAGEMENT OF TRANSTHYRETIN CARDIAC AMYLOIDOSIS

Background: Transthyretin Cardiac Amyloidosis (ATTR-CM) is an underdiagnosed cause of heart failure with preserved ejection fraction. Patients often experience substantial delays before receiving a diagnosis and initiating treatment. These delays contribute to worse outcomes for patients with ATTR-CM. Transthoracic echocardiography (TTE) is the primary cardiac imaging modality for screening and raising suspicion of ATTR-CM. However, it must be followed by a pyrophosphate (PYP) scan to confirm diagnosis. Unfortunately, like many other centres, our institution faces significant delays in suspicion, diagnosis, and treatment initiation. To address this, we implemented a Plan-Do-Study-Act (PDSA) cycle to map the ATTR-CM journey through our system to identify points of delay and barriers to timely care. We herein report the results of a multifaceted quality improvement (QI) initiative, which included periodic educational rounds for clinicians, sonographers, and echocardiographers, streamlining of the PYP testing process, and expediting assessment in the heart function clinic. These efforts aimed to reduce delays in the suspicion, diagnosis, and treatment of ATTR-CM.

METHODS AND RESULTS: We retrospectively reviewed patients with suspected ATTR-CM who underwent PYP scans between April 2022-April 2023 [pre-intervention] and May 2023-January 2025 [post-intervention]. Performance indicators included the number of TTEs performed before clinical suspicion of ATTR-CM, and the time from TTE-to-PYP scan. Process measures encompassed educational events conducted during the intervention. Balancing measures included the number of PYP scans/month as a proxy for resource utilization and the rate of negative PYP scans reflecting the accuracy of ATTR-CM suspicion.
Of the 190 patients, 62 had confirmed ATTR-CM. During the pre-intervention, 31 PYP scans were performed, which increased substantially to 145 post-intervention. This corresponded to a rise in the median number of scans/month from 2 (interquartile range [IQR] = 1–4) in pre-intervention to 5 scans/month (IQR = 3–12) post-intervention (p=.002). Additionally, the rate of negative scans increased from 51.6% pre-intervention to 74.5% post-intervention (p=.011). The median time from TTE-to-PYP decreased from 6.30 months (IQR = 3.87–12.28) to 2.56 months (IQR = .65–4.27; p<.001), and the median number of TTEs within 5 years of positive PYP scans decreased from 2 (IQR = 1–2) to 1 (IQR = 0–1; p=.038).

Conclusion: Our multifaceted intervention aimed at physician education and diagnostic streamlining at the institutional level led to improvement in ATTR-CM diagnosis. However, the increase in negative PYP scan rates reflects heightened awareness and underscores the ongoing need for continued education, support, and quality assurance efforts.