Watch out for red-flag signs and symptoms to identify hATTR early1-4

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Click or tap categories to view additional red flags.

Tap categories to view additional red flags.

SENSORIMOTOR NEUROPATHY CARDIAC MUSCULOSKELETAL AUTONOMIC DYSFUNCTION NEPHROPATHY

SENSORIMOTOR NEUROPATHY1-4

Painful Neuropathy In Hands And Feet

Painful neuropathy
in hands and feet

Muscle Weakness, Difficulty Walking, And Falls

Muscle weakness, difficulty walking, and falls

CARDIAC1-4

Heart Failure

Heart failure

Bradyarrhythmias/Conduction Abnormalities/ Pacemakers

Bradyarrhythmias/ conduction abnormalities/ pacemakers

Atrial Fibrillation

Atrial fibrillation

MUSCULOSKELETAL1-4

Back Pain/Lumbar Spinal Stenosis

Back pain/lumbar spinal stenosis

Trigger Finger

Trigger finger

Ruptured Biceps Tendon/Popeye Sign

Ruptured biceps tendon/Popeye sign

Bilateral Carpal Tunnel Syndrome

Bilateral carpal tunnel syndrome

Shoulder, Knee, And Hip Pain Or Surgery

Shoulder, knee, and hip pain or surgery

AUTONOMIC DYSFUNCTION1-4

Orthostatic Hypotension/Intolerance To Blood Pressure Medications

Orthostatic hypotension/ intolerance to blood pressure medications

Erectile Dysfunction

Erectile dysfunction

Chronic Diarrhea/ Constipation/Weight Loss

Chronic diarrhoea/ constipation/weight loss

NEPHROPATHY2,4

Proteinuria

Proteinuria

Kidney Renal Failure

Renal failure

Patients with mixed presentation may already be in your practice

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Although patients may present with predominantly polyneuropathy (PN) or cardiomyopathy (CM) symptoms, hATTR is a systemic disease where a significant proportion of patients have mixed presentation of both PN and CM.1,2

  • Polyneuropathy of hereditary transthyretin-mediated amyloidosis (hATTR-PN) is defined as patients presenting with manifestations that predominantly affect sensorimotor and autonomic peripheral nerves1

  • Cardiomyopathy of hereditary transthyretin-mediated amyloidosis (hATTR-CM) is defined as patients presenting with manifestations that predominantly affect the cardiovascular system1

Patients With ATTR Who Have A Mixed PN And CM Presentation

OF PATIENTS WITH HEREDITARY ATTR HAVE MIXED PHENOTYPE5*

There’s a critical need to identify patients with mixed presentation1

Discover diagnostic tools
Patient Diagonistic Tools

*Retrospective analysis of n=1551 patients with hATTR identified via commercial and Medicare fee-for-service medical and pharmacy claims from 2018-2020.5

Understanding the distinguishing features of hATTR symptoms

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Rapid worsening of PN symptoms is a warning sign for underlying hATTR

Polyneuropathy Progression

Polyneuropathy due to ATTR can be 10 times more rapid than diabetic neuropathy.6

Symptom progression can escalate rapidly from painful tingling to unsteadiness or labored, painful walking.7

Atypical features of HF
associated with hATTR8

Cardiomyopathy Progression

Poor tolerance to standard HF guideline-directed medical therapy such as:

  • ß-blockers: Patients with ATTR-CM, a restrictive cardiomyopathy, have a greater dependence on heart rate to maintain cardiac output

  • RAAS inhibitors: May be poorly tolerated due to vasodilation, particularly in patients with underlying dysautonomia leading to orthostatic hypotension

Learn how to diagnose hATTR

ATTR, transthyretin-mediated amyloidosis; ATTR-CM, cardiomyopathy of transthyretin-mediated amyloidosis; HF, heart failure; RAAS, renin-angiotensin-aldosterone system.

References: 1. Nativi‑Nicolau JN, Karam C, Khella S, Maurer MS. Screening for ATTR amyloidosis in the clinic: overlapping disorders, misdiagnosis, and multiorgan awareness. Heart Fail Rev. 2022;27(3):785-793. 2. Gertz MA. Hereditary ATTR amyloidosis: burden of illness and diagnostic challenges. Am J Manag Care. 2017;23(7 Suppl):S107-S112. 3. Adams D, Algalarrondo V, Polydefkis M, Sarswat N, Slama MS, Nativi-Nicolau J. Expert opinion on monitoring symptomatic hereditary transthyretin-mediated amyloidosis and assessment of disease progression. Orphanet J Rare Dis. 2021;16(1):411. 4. Gertz M, Adams D, Ando Y, et al. Avoiding misdiagnosis: expert consensus recommendations for the suspicion and diagnosis of transthyretin amyloidosis for the general practitioner. BMC Fam Pract. 2020;21(1):198. 5. Bazell C, Alston M, Kumar N, et al. Descriptive characteristics of patients diagnosed with transthyretin amyloidosis (ATTR) in the Medicare fee-for-service and commercial populations [abstract and poster]. International Symposium of Amyloidosis; May 26-30, 2024; Rochester, MN. 6. Berk JL, Suhr OB, Obici L, et al. Repurposing diflunisal for familial amyloid polyneuropathy: a randomized clinical trial. JAMA. 2013;310(24):2658-2667. 7. Conceição I, González-Duarte A, Obici L, et al. “Red-flag” symptom clusters in transthyretin familial amyloid polyneuropathy. J Peripher Nerv Syst. 2016;21(1):5-9. 8. Kittleson MM, Ruberg FL, Ambardekar AV, et al; Writing Committee. 2023 ACC Expert Consensus Decision Pathway on comprehensive multidisciplinary care for the patient with cardiac amyloidosis: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2023;81(11):1076-1126.

 

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