Transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized yet frequently underdiagnosed cause of heart failure, particularly among older adults. The American Heart Association's 2026 Heart Disease and Stroke Statistics Update reports that up to 13% of older adults hospitalized with heart failure with preserved ejection fraction may have ATTR‑CM, underscoring substantial opportunities to improve diagnosis in routine clinical care.
The American Heart Association, a relentless force changing the future of health for everyone, everywhere, has launched a multicenter cluster randomized trial to evaluate whether a structured, provider-focused evidence-based educational intervention can improve diagnostic testing and confirmed diagnosis of ATTR‑CM among patients hospitalized with heart failure.
The trial, known as TTRANSLATE-ATTR, is actively enrolling and collecting data across hospitals participating in the Association's Get With The Guidelines® - Heart Failure quality improvement program. Participating sites are randomized as part of the study design to integrate evidence-based tools — including tailored performance feedback, expert-led ATTR coaching and practical diagnostic algorithms — directly into routine hospital workflows. This will enable evaluation of the impact of a structured intervention compared with usual care.
"This study is designed to test, in a rigorous and practical way, whether targeted clinician education can help close persistent gaps in the recognition of ATTR‑CM in hospitalized patients with heart failure," said Gregg C. Fonarow, M.D., FAHA, American Heart Association volunteer who helped establish the Get With The Guidelines program and member of the trial's steering committee. Fonarow is also director of the Ahmanson-UCLA Cardiomyopathy Center, co-director of the Preventative Cardiology Program and the Eliot Corday Chair in Cardiovascular Medicine and Science at the University of California, Los Angeles. "By embedding the trial within the Get With The Guidelines - Heart Failure infrastructure, we're able to evaluate an intervention in real‑world hospital settings with the potential for broad relevance."
The cluster randomized design assigns hospitals — rather than individual patients — in a 1:1 ratio to either a control group or an intervention group, which comprises standard care plus a structured, provider-focused initiative. The trial leverages the established Get With The Guidelines – Heart Failure registry to:
- Identify eligible people hospitalized with heart failure;
- Track site-level rates of ATTR-CM diagnostic testing and confirmed diagnoses; and
- Evaluate variation in diagnostic practices across randomized hospitals before and after a structured provider education intervention.
All analyses will be conducted by statisticians at the Duke Clinical Research Institute (DCRI) under the scientific leadership of the expert steering committee.
If the intervention is shown to improve diagnostic testing or detection of ATTR‑CM, study findings and implementation insights may inform future dissemination efforts across the broader Get With The Guidelines – Heart Failure network among its more than 800 participating hospitals.
Unlike awareness initiatives, this trial is designed to generate evidence on whether a structured educational approach measurably changes clinical practice. Results will be shared through scientific manuscripts and presentations at national cardiovascular meetings.
"The goal is not only to understand whether this approach works, but also how it might be scaled responsibly if the findings support broader adoption," Fonarow said.
The trial is financially supported by AstraZeneca. The American Heart Association maintains oversight of study execution, data governance and scientific integrity. Data analysis is conducted independently by the Duke Clinical Research Institute.
"ATTR-CM remains a challenging condition to recognize in everyday clinical practice," said Helen Yeh, PhD, vice president, biopharmaceutical medical, cardiovascular, renal and metabolism (CVRM), at AstraZeneca. "In line with our commitment to advancing diagnosis and early treatment initiation in ATTR-CM, we are proud to support this rigorous, real-world study to evaluate whether structured provider education, embedded within existing hospital workflows, can help close persistent gaps in diagnosis and inform future efforts to improve care for people with heart failure."
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