Timely ATTR-CM Diagnosis: Addressing Social Determinants of Health

Announcer:
Welcome to Heart Matters on ReachMD. On this episode, we’ll hear from Dr. Kevin Alexander, who’s an Assistant Professor of Medicine at Stanford University School of Medicine. He’ll be discussing the impact of social determinants of health on timely detection in ATTR-CM. Here’s Dr. Alexander now.

Dr. Alexander:
Social determinants of health are very important to address across the spectrum of diseases, and ATTR-CM is no exception. ATTR-CM still remains a relatively complex disease to diagnose in terms of needing the awareness as well as a series of testing in order to get to the right diagnosis, and we see that sometimes, those structural barriers or access to healthcare in general could be magnified for conditions like ATTR-CM, where you need to be able to see multiple specialists sometimes and to get multiple tests performed.

So there's a number of tools that have been developed to assess the impact of social determinants of health on clinical outcomes. There have been a number of indices that have been developed to understand the burden of access to healthcare or social determinants of health, things like the Social Deprivation Index, which can give information about degrees of deprivation based on where you live or your zip code. We've used that tool in some of our own research to look at the impacts of social determinants of health on ATTR-CM diagnosis. We had a study that was recently published in JACC: Heart Failure looking at the association between SDI scores of the Social Deprivation Index and the timing of diagnosis in our Stanford Amyloid Center, as well as in the Queen’s Medical Center in Hawaii. In both cohorts, what we saw was that patients who came from high areas of social deprivation, they were much more likely to present with late-stage disease at the time of diagnosis, I think further just highlighting the fact that in addition to demographic or clinical variables, the social determinants of health can have a great impact on the timing of diagnosis for ATTR-CM.

In terms of key determinants that can influence ATTR-CM diagnosis, there's a number of things within social determinants of health. In that study that I mentioned, when we broke down the components of the Social Deprivation Index, what we found is that access to transportation as well as being in an area of high poverty were both strongly associated with this likelihood of being diagnosed with advanced-stage ATTR. So what we took away from that is that there are certainly financial barriers that can limit access to care, which is not unique to ATTR-CM, but also, transportation is an important piece, and I think that that reflects the fact that there's still a relatively small number of Amyloid Centers of Excellence the patients have access to, and many times patients have to travel great distances in order to seek these resources. And so that can be an additional barrier.  

Announcer:
That was Dr. Kevin Alexander talking about how social determinants of health can influence ATTR-CM diagnosis. To access this and other episodes in our series, visit Heart Matters on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!