Dr. Oscar M. Westin is a PHd student and a medical doctor at the University Hospital of Copenhagen's Heart Center, Rigshospitalet. In this Podcast Dr. Westin speaks on the Two Decades of Cardiac Amyloidosis: A Danish Nationwide Study.
Link to Abstract-
Cardiac amyloidosis (CA) is linked to a bad prognosis. According to screening studies, CA is often ignored, especially in the elderly. Recent therapy improvements have drawn attention to the condition, although data on CA epidemiology across time is scarce.
The goal of this study was to describe all CA patients in Denmark from 1998 to 2017, as well as to look at changes in patient characteristics over time.
In Danish nationwide registries, all patients with any kind of amyloidosis diagnosed between 1998 and 2017, as well as their comorbidities and medication, were identified. Any diagnosis code for amyloidosis paired with a diagnosis code for heart failure, cardiomyopathy, or atrial fibrillation, or a procedural code for pacemaker installation, regardless of order, was classified as CA. The index date was established as the date on which those criteria were met. By index date, patients were separated into 5-year segments. We also included control subjects (1:4 ratio) from the general population as a comparison.
619 patients met the CA requirements. The median age at baseline grew from 67.4 years (interquartile range [IQR]: 53.9-75.2 years) in 1998-2002 to 72.3 years in 2013-2017. (IQR: 66.0-79.3 years). Male patients grew from 62.1 percent to 66.2 percent of all patients. In the Danish population aged 65 years, the incidence of CA increased from 0.88 to 3.56 per 100,000 person-years, whereas 2-year mortality reduced from 82.6 percent (IQR: 69.9 percent -90.5 percent) to 50.2 percent (IQR: 43.1 percent -56.9 percent ). CA patients had a considerably greater mortality rate than control participants (log-rank test: P 0.0001).
On a nationwide scale, CA, as defined in this study, was becoming more prevalent. The rising number of male patients and median age indicate that wild-type transthyretin amyloidosis is to blame. The fact that earlier, less advanced illnesses are being recognized more often could explain the lower fatality rate.