CONGRESS ABSTRACT

Background: The incidence of cardiac amyloidosis (CA) is constantly rising. Studies on CA awareness among cardiologists, internal medicine specialists, and geriatricians have identified various gaps in physicians' knowledge. General practitioners (GPs) are often gatekeepers who may generate a suspicion and influence time to diagnosis. However, little is known about GPs’ disease awareness and involvement in managing CA. Methods: A qualitative descriptive study with semi-structured interviews was conducted through videoconferencing and audio-recorded calls with GPs in Tuscany. The interviews were transcribed verbatim and analyzed using thematic analysis based on Braun and Clark model. Results: 10 GPs participated in the study, all defining CA as a chronic disease characterised by the deposition of proteins in heart tissue. For 4 of them CA is still a rare condition, for 4 it is not rare anymore, 2 were doubtful. As for professional training, very few reported lack of previous education, while the majority received some knowledge, only 1 received complete education.  Heart failure(9), carpal tunnel syndrome(5), spontaneous tendon rupture(5), monoclonal gammopathy(3), dyspnea(3), increased ventricular thickness(2), syncope(2) and neuropathy(1) were reported as red flags of CA. In case of suspicion of CA, GPs would prescribe blood and urine routine tests(9), urine and blood immunofixation(3), BNP and troponin testing(4), EKG, echocardiography and subsequent cardiological visit(9), genetic testing(5), bone scintigraphy(4) and cardiac MRI(3), abdominal ultrasound and lymphatic system ultrasound(1). Specific treatment existence was known to the majority. All GPs see their role in the patient’s path in a suspicion of CA, referral to a specialist, and guiding the patient throughout the entire diagnostic and therapeutic process, managing symptoms(3), exams(3), therapy(2), and complications(1). All GPs know a reference center in their region, and many would like to have contact with a specialist. To fulfill their role in the patient’s pathway GPs expressed a need for refreshing knowledge on CA, focusing on a practical approach from the GP’s point of view, mostly preferring in-person meetings, lectures, and case studies; only 2 prefer distance learning; for 1, both ways are acceptable. Conclusion: Our study shows a lack of confidence and knowledge of GPs among red flags and diagnostic procedures and demonstrates a huge need for specific professional updates on CA.