The presence of cardiac amyloidosis in patients hospitalized with heart failure (HF) may be associated with higher rates of inpatient mortality and 30-day readmissions, according to a study published Dec. 15 in JACC: CardioOncology.

Sameer Arora, MD, MPH, et al., reviewed 1,593,360 hospitalizations with a primary diagnosis of HF between 2010 and 2015. Of the patients hospitalized for HF, 2,846 (0.18%) had a secondary diagnosis of amyloidosis. These patients were then matched to 8,515 patients hospitalized for HF without amyloidosis. Of the matched patients, 63% were men and the median age was 75 years. Those with amyloidosis were more likely than those without amyloidosis to have malignancy (20% vs. 4%) and kidney disease (56% vs. 45%). Patients with amyloidosis had lower prevalence of chronic pulmonary disease, diabetes, history of myocardial infarction, peripheral vascular disease, coronary artery disease, hypertension and obesity.

Results showed that the primary outcome of inpatient mortality was 6% in patients with amyloidosis vs. 3% in those without amyloidosis. Among those with amyloidosis, 30-day readmission was 24% vs. 21% in those without. In unadjusted analysis, HF with amyloidosis was associated with higher odds of in-hospital morality (odds ratio [OR]: 1.46; 95% confidence interval [CI]: 1.17 to 1.82) and 30-day readmissions (OR: 1.17; 95% CI: 1.05 to 1.31). The increased likelihood of readmission among those with amyloidosis was largely driven by readmission for noncardiovascular reasons. There was not a significant difference in cardiovascular-related readmissions between the two groups. Patients with amyloidosis also had a longer length of stay.

According to the researchers, the study demonstrates that amyloidosis was associated with a significantly higher risk of inpatient mortality and 30-day readmission in patients hospitalized for HF. "With the advent of new life-prolonging therapies for cardiac amyloidosis, these results emphasize the need to develop more effective screening strategies to facilitate early diagnosis of amyloidosis in HF patients," they conclude.

They study confirms that amyloidosis "is significantly underdiagnosed among patients admitted with decompensated HF," Karen E. Joynt Maddox, MD, MPH, FACC, and Kathleen W. Zhang, MD, FACC, write in an accompanying editorial comment. They add that "a national effort is needed to better care for these patients, who are at high risk for missed diagnosis and treatment."

JACC: CardioOncology will publish a special focus issue on amyloidosis in 2021. Original research submissions spanning the theme will be considered, including those examining epidemiology, diagnosis and prognosis, clinical management, phenotyping, pathophysiology, emerging therapies, comorbidities, the role of imaging and biomarkers, and other relevant issues. Submissions are due by April 15, 2021. Learn more on JACC.org.

Clinical Topics: Heart Failure and Cardiomyopathies, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure

Keywords: Patient Readmission, Coronary Artery Disease, Inpatients, Length of Stay, Myocardial Infarction, Heart Failure, Amyloidosis, Diabetes Mellitus, Obesity

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