EPIDEMIOLOGY AND FUTURE BURDEN OF TRANSTHYRETIN AMYLOID CARDIOMYOPATHY (ATTR-CM) AMONG ADULTS IN THE UNITED STATES: A SYSTEMATIC REVIEW

OBJECTIVES: To synthesize epidemiology of ATTR-CM among adults in the United States (US) and project incidence and prevalence through 2030 to inform screening strategies, service capacity, and budget planning.
METHODS: A systematic review was conducted (PubMed, Medline, EMBASE, and DOAJ; inception-Dec 2025) using terms for transthyretin amyloid cardiomyopathy. US studies reporting adult ATTR CM incidence/prevalence were eligible; sub-cohort screening yields (e.g., HFpEF, carpal tunnel syndrome) were summarized separately. Forecasting of incidence and prevalence through 2030 was performed using historical trends and adjusted for age and gender only. United Nation 2024 population dataset was used for estimating the case counts.
RESULTS: Four studies met the inclusion criteria. An incidence of 12.7 per 1,000,000 (95% CI: 7.8-16.6) and prevalence of 41.1 per 1,000,000 (95% CI: 31.0-49.1) was reported in 2022, with higher burden in males (75%) and individuals aged ≥65 years (85%). The comorbidity proportions were 69% for hypertension, 27% for diabetes, 30% for coronary artery disease, and 65% for hyperlipidemia. In clinical subgroups, ATTR‑CM is observed in 10.2% of HFpEF patients, while it occurs in 7.1% individuals with carpal tunnel syndrome. The proportion of ATTR-CM patients who received pharmacologic treatment in 2025 was 81%. Forecasts indicated rising disease burden, with incidence increasing from 16.2 per 1,000,000 (case count: 4,445) in 2025 to 22.2 per 1,000,000 (case count: 6,325) in 2030, and prevalence increasing from 60.9 per 1,000,000 (case count: 16,709) in 2025 to 99.3 per 1,000,000 (case count: 28,317) in 2030.
CONCLUSIONS: ATTR‑CM shows increasing epidemiologic burden with strong age dependence, male predominance, substantial comorbidity overlap, and rising projected incidence and prevalence through 2030. For HEOR and policy, findings support targeted screening in older HFpEF populations. Further work should expand registries, standardize case definitions, and quantify costs, mortality, and quality of life to refine budget impact and value assessments.