Abstract 4364057: Structured Workflow Integration Improves Polyneuropathy Screening and Multidisciplinary Care for Patients with Hereditary Transthyretin Amyloidosis

Abstract

Background: Patients with hereditary transthyretin amyloidosis (ATTRv) are often referred for cardiac evaluation, resulting in a primary focus on transthyretin amyloid cardiomyopathy (ATTR-CM). However, many with variants linked to ATTR-CM also experience polyneuropathy (ATTRv-PN). Neurological assessment is often overlooked, missing key opportunities to slow disease progression and maximize quality of life. This program aimed to improve workflows and strengthen multidisciplinary coordination for patients with ATTRv-PN. Research Question: Can implementing structured workflow processes improve early PN screening, care coordination, and patient-centered management for individuals with ATTRv-PN? Methods: Cardiologists and neurologists from three amyloidosis centers participated in focus groups and completed baseline surveys (N=34) from February to December 2023. Teams engaged in audit-feedback sessions, completed pre- and post-activity surveys, reviewed performance data, and developed action plans. Clinic champions participating in the program completed follow-up surveys (N=6). Each site conducted baseline (N=151) and follow-up (N=150) chart audits. Chi-square tests were used for statistical comparisons. Results: Chart audits performed before and after the audit-feedback sessions showed PN screening to support ATTRv diagnosis increased from 10% at baseline to 57% at follow-up (P <0.001). PN screening at any time during care rose from 38% to 76% (P <0.001). Baseline provider surveys revealed 13% of institutions had protocols for neurological workup, 33% had diagnostic protocols, and 40% lacked ATTRv protocols altogether. Documentation of ATTRv management strategies improved from 31% to 86% (P <0.001). Shared decision-making documentation also increased, including discussions on goals of ATTRv care (56% to 79%, P <0.001) and patient barriers (46% to 71%, P <0.001). After the program, 83% of providers reported improved collaboration between cardiology and neurology, and 100% noted more consistent evaluation for ATTRv-PN symptoms. Strategies linked to these improvements included use of a PN screening questionnaire for new referrals, neurology referrals for all patients with ATTRv, and baseline screening for presymptomatic patients. Conclusion: Practical structured workflow strategies can be implemented by amyloidosis centers to enhance early PN screening, patient-centered care, and multidisciplinary collaboration, ultimately improving care for patients with ATTRv-PN.