Abstract Body (Do not enter title and authors here): Background: The efficacy of tafamidis treatment in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) is well known, as supported by findings in the ATTR-ACT trial. However, to our knowledge, no study has investigated the racial implications on the economic effects of tafamidis tied to heart failure (HF) outcomes by using each patient as their own control.

Hypothesis: Racial disparities lead to delayed diagnosis and treatment, resulting in a reduced benefit of tafamidis for decreasing costs associated with HF admissions in Black patients.

Methods: We conducted a retrospective pre-post study of 186 ATTR-CM patients on tafamidis, stratified by race and amyloid subtype. Each patient served as their own control. The primary outcome was healthcare cost savings (using our institutional cost of $2,920/hospital day). Secondary outcomes included total HF admissions and length of stay (LOS) during 90 days pre- and post-tafamidis. We compared baseline NYHA class distribution between racial groups and analyzed treatment responses across hereditary (hATTR-CM) versus wild-type (wtATTR-CM) subtypes. Statistical analysis used Mann-Whitney U tests for inter-group comparisons and Wilcoxon signed-rank tests for pre-post outcomes.

Results: Black patients had a median reduction in LOS of 7.5 days, compared to 3.5 days for White patients, leading to cost savings of $21,900 versus $10,220 (Figure 1). Total hospital admissions and LOS were higher for Black patients across NYHA classes II and III (Figures 2 and 3). At tafamidis initiation, Black patients had a higher baseline NYHA class (mean 2.50 vs 2.13, p=0.010). There was no significant difference in treatment delay from diagnosis, with Black patients experiencing a median delay of 68.5 days compared to 62.5 days (p=0.169). Additionally, the mean reduction in LOS did not differ among Black hATTR-CM (n=10), Black wtATTR-CM (n=7), and White wtATTR-CM (n=14) groups, with reductions of 4.70 days, 5.43 days, and 3.21 days, respectively (p=0.211).

Conclusion: Black patients presented with more advanced disease but achieved greater absolute benefits and cost savings from tafamidis. With no treatment delays, later presentation likely reflects disparities in diagnosis and healthcare access, resulting in higher pre-treatment costs that resolved with appropriate therapy. These findings underscore the need for early diagnosis and equitable specialist access, while confirming universal tafamidis efficacy across diverse populations.