Outpatient clinic visits before and after hospitalizations for heart failure with and without transthyretin amyloid cardiomyopathy: from the TTRanslate-HF program

Background

Transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized cause of heart failure (HF). Outpatient clinic visits are an important opportunity to optimize evidence-based medications for HF. Yet, large-scale data detailing the type and frequency of outpatient visits for patients with HF are limited, and the degree to which longitudinal outpatient follow-up may differ for patients with HF with and without ATTR-CM is unclear.

Purpose

To characterize the frequency and type of outpatient clinic visits before and after HF hospitalization among those with and without ATTR-CM.

Methods

This study included US Medicare patients hospitalized for HF in the Get With The Guidelines – Heart Failure registry between January 2021 and June 2024. Outpatient clinic visits were assessed for the 6 months before and after hospitalization. The frequency and specialty type (cardiology, neurology, primary care, other) of outpatient visits were examined, and compared for those with versus without ATTR-CM, as noted in the registry case report and abstracted from clinical documentation.

Results

The study included 229 patients with ATTR-CM and 112,641 without ATTR-CM. Of those with ATTR-CM, 73 (31.9%) were diagnosed prior to index hospitalization, 65 (28.4%) during index hospitalization, and 91 (39.7%) were missing data on time of diagnosis. Median age was similar between HF patients with and without ATTR-CM (82 vs 81 years, p=0.08), but patients with ATTR-CM were less likely to be female (30% vs 53%, p<0.001).

Overall, 102,888 (91%) had ≥1 outpatient visit of any kind in the 6 months before hospitalization, and 98,870 (87%) patients had ≥1 outpatient visit of any kind within 6 months after hospitalization. Patients had a median (IQR) 5 (3-9) outpatient visits in the 6 months before hospitalization, and a median 6 (2-9) in the 6 months after hospitalization.

Compared with HF without ATTR-CM, those with ATTR-CM were more likely to have ≥1 visit, and had a higher median number of visits (Figure 1). Six months before and after HF hospitalization, most patients were seen by cardiology (50.3% and 57.2%) and primary care (63.1% vs 56.4%). Compared with HF without ATTR-CM, patients with ATTR-CM were more likely to be seen in cardiology clinic before HF hospitalization, but were not more likely to be seen by neurology or primary care (Figure 2).

Conclusions

Among older US adults hospitalized for HF, regardless of ATTR-CM status, patients were seen a median 5-7 times in outpatient clinic during the 6 months before hospitalization, and a comparable number of times in the 6 months after hospitalization. Compared with HF without ATTR-CM, those with ATTR-CM tended to have more frequent visits, driven by higher rates of cardiology and other subspecialty visits. In aggregate, these data suggest ample outpatient opportunities for optimizing disease-modifying therapies before and after HF hospitalization, including patients with and without ATTR-CM.Visits Before & After HF HospitalizationFor image description, please refer to the figure legend and surrounding text.Type of Outpatient Clinic VisitsFor image description, please refer to the figure legend and surrounding text.