In an interview with Pharmacy Times during the 2026 Cardiology Day of Education, Craig Beavers, PharmD, FACC, FAHA, FCCP, BCCP, BCPS (AQ-Cardiology), CACP, a cardiovascular clinical pharmacist with Baptist Health System and adjunct associate professor at the University of Kentucky College of Pharmacy, discussed the pharmacist's critical role in recognizing, evaluating, and managing transthyretin amyloidosis cardiomyopathy (ATTR-CM).
Beavers emphasized that patients with heart failure who fail to tolerate guideline-directed medical therapy represent a key clinical red flag for ATTR-CM, alongside other diagnostic signals such as carpal tunnel syndrome, aortic stenosis, and polyneuropathy. He stressed that pharmacists should avoid dismissing these patients as simply difficult to manage.
On the treatment landscape, Beavers noted that pharmacists must understand the clinical trial populations and outcomes supporting available agents, including their mortality and quality-of-life benefits. Because current evidence suggests limited efficacy differences among agents, he argued that therapy selection should be driven by patient preference, administration considerations, and insurance coverage.
Beavers also outlined the multidisciplinary opportunities available to pharmacists, from building population health dashboards to support early identification to guiding formulary decisions, facilitating therapy access, and ensuring long-term adherence and monitoring—reinforcing that pharmacists can and should be engaged at every stage of the ATTR-CM care continuum.
Pharmacy Times: Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is notoriously underdiagnosed. What are the clinical red flags that should prompt a pharmacist to raise the possibility with the care team?
Key Takeaways
- Heart failure patients who cannot tolerate guideline-directed medical therapy are a primary clinical red flag for ATTR-CM, along with symptoms such as carpal tunnel syndrome, aortic stenosis, and polyneuropathy—and pharmacists should not dismiss these patients as simply treatment-resistant.
- When evaluating ATTR-CM therapies, pharmacists should assess clinical trial enrollment criteria, patient staging, and outcomes data, including mortality and quality-of-life benefits, because current evidence suggests comparable efficacy among agents; patient preference and insurance coverage should guide therapy selection.
- Pharmacists can contribute to ATTR-CM care at multiple levels, including population health surveillance, proactive patient identification, treatment decision support, access navigation, adherence monitoring, and managed care cost triage—making them essential across the full care continuum.
Craig Beavers, PharmD, FACC, FAHA, FCCP, BCCP, BCPS (AQ-Cardiology), CACP: I think definitely being aware of patients with heart failure who are not able to tolerate traditional guideline-directed medical therapy should be a red flag. Since pharmacists are often engaged in managing, monitoring, and titrating therapy, those patients who appear or seem to be difficult to manage should be those clinical red flags. Then you can think of the other constellation of symptoms that can occur; patients who may have carpal tunnel syndrome can be a red flag. A lot of patients with aortic stenosis, you're working with the team to help identify: are there other things in the constellation of symptoms? Are they having polyneuropathy or other things that kind of look or smell or give you a sense that something isn't right with this picture?
But I think the biggest takeaway, or at least a good starting point, is not to write off those patients who are not tolerating traditional guideline-directed medical therapy in heart failure.
Pharmacy Times: The treatment landscape for ATTR-CM has expanded significantly in recent years. What should pharmacists understand about the evidence behind emerging therapies when making formulary or access recommendations?
Beavers: I think it's very important for pharmacists to understand what the treatment landscape is, because it is expanding. Understanding the clinical trial data—who was enrolled in the clinical trials—so understanding what type of New York Heart Association (NYHA) class they had, what their 6-minute walk times were at the beginning of the trial, and where these patients are in terms of their ATTR journey.
Knowing that, for example, a patient who is in a later stage might not derive benefit from these therapies, but then looking at the patient population, understanding the outcomes, and knowing that there's a mortality benefit and a quality of life improvement benefit from these therapies. And then, more importantly, what's germane to this is that because each of the medications has slightly different administration and processes toward access, understanding that part of the landscape is key. Because at the current rate, the evidence suggests there may be no difference in efficacy among the different agents, so it's really about understanding patient preference—what they're willing to take, what their insurance is able to cover—to help the pharmacist guide therapy selection.
Pharmacy Times: What does an effective multidisciplinary approach to ATTR-CM look like in practice, and where does the pharmacist sit in that care continuum?
Beavers: I think the pharmacist plays—in my mind, and could and should play—a vital role in this care continuum. I think, first and foremost, as we know, there are gaps in identifying and finding these patients, working with teams to develop population health processes to look at, for example, patients who are not tolerating guideline-directed medical therapy or finding those patients who have had a lot of the testing done and then doing some proactive outreach to say, "Hey, we have a program or a clinic that we can get patients into to help do additional testing and managing."
And then, of course, once you diagnose—or find that a patient has ATTR cardiomyopathy—help in terms of the treatment decision and manage the other guideline-directed medical therapy that they can tolerate, which is a little different than our normal heart failure patients, and then, of course, help with access and make sure the patient stays on therapy and monitor that therapy through the traditional lens of what a pharmacist does. I think there's a broad brush that pharmacists can be engaged in, both in the clinic space and through the managed care process, in terms of helping understand and triage the cost of therapy, how to access therapy, and what that would look like. You can have the population health perspective, where the pharmacist is helping devise dashboards and tools to help identify and get patients into programs. I think there's a multitude of ways that pharmacists should and could be engaged in this process.
