Identifying implementation strategies to increase the early detection of cardiac amyloidosis: a pre-implementation study

Introduction: Cardiac amyloidosis (CA) has been considered a rare disease. However, its prevalence is growing as healthcare practitioners have new, less invasive diagnostic tools that aid in the early detection of this disease. Bone scintigraphy with monoclonal protein testing is one such evidence-based, noninvasive screening option that can be offered in community healthcare facilities. This work aims to identify intervention strategies to improve the timely workup of transthyretin CA, including evidence-based practices such as bone scintigraphy and monoclonal protein testing. Methods: The team used rapid qualitative content analysis to develop a system map of care for cardiac amyloidosis, guided by both patient and healthcare expert perspectives. To explore the map's utility and accuracy, the team conducted follow-up in-depth interviews with clinicians. They explored clinicians' perspectives on strategies to facilitate the early diagnosis of CA and explored barriers and implementation strategies that can influence the diagnostic work-up for CA. Results: Clinicians provided recommendations for how to expand the map, particularly in terms of including additional healthcare professionals, screening strategies, and barriers to care for patients. After expanding the preliminary system map of care, the team identified 23 distinct strategies to improve the early detection of CA. Clinicians recommended additional strategies, such as patient and provider education, patient take-back, the use of artificial intelligence with electronic health record data, and the formation of healthcare teams specializing in cardiac amyloidosis, to enhance early detection and treatment of this condition. Discussion: This work can inform researchers and clinicians about selecting and implementing intervention and implementation strategies within health systems to enhance the early detection of cardiac amyloidosis.