Abstract Body (Do not enter title and authors here): Introduction: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive, often fatal disease. Recognition and diagnosis of ATTR-CM have increased due to greater awareness, improved diagnostics, and introduction of disease-modifying treatments (DMT).

Hypothesis: Geographic disparities in ATTR-CM prevalence exist due to healthcare system and societal factors that impact the Veterans Affairs (VA) population.

Methods: This study included a retrospective analysis of electronic health records of veterans with ATTR-CM (01/2012-12/2021) across all VA facilities in the United States (US). The primary outcome of this analysis was ATTR-CM prevalence, defined as cases per 100,000 person-years (PY). Prevalence was analyzed by state after the approval of DMT (2019). The distribution of US amyloidosis centers, classified by the International Society of Amyloidosis, Amyloidosis Foundation, and/or Amyloid Research Consortium, was also assessed.

Results: A total of 2433 patients with ATTR-CM were included. The majority (85.7%) were aged ≥65 years, with 20.8% aged ≥85 years. Most (86.8%) patients were male; 51.5% were White and 41.3% were Black/African American. ATTR-CM prevalence in veterans was 6.1 per 100,000 PY in 2012 and increased to 16.8 in 2021 (Figure 1). After 2019, the prevalence in veterans was high in Oregon (50.9), Utah (39.5), and South Dakota (35.4), and in many states in the Northeast (Massachusetts, 43.2; Rhode Island, 43.0; Vermont, 33.6; Connecticut, 29.3) (Figure 2). Prevalence appeared to correlate with the distribution of amyloidosis centers in many regions, though prevalence was high in New Mexico and South Dakota despite the lack of dedicated amyloidosis centers.

Conclusion: The documented prevalence of ATTR-CM increased over time in US veterans, though geographic disparities exist at the state level that appear to correlate with access to amyloidosis centers. For regions with lower-than-expected prevalence, strategies are needed to address regional disparities in disease awareness, diagnosis, and access to care.