Abstract
Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy increasingly recognized as an important contributor to heart failure (HF), particularly with advances in noninvasive diagnostics. However, the global prevalence of CA remains poorly defined, with substantial variability across regions. We conducted a systematic review and meta-analysis of studies reporting the prevalence of CA among HF populations. The protocol was registered with PROSPERO and followed the PRISMA reporting guideline. Searches of PubMed Central, Cochrane, EMBASE and Web of Science identified eligible studies from inception through 2025. CA was diagnosed using technetium-labeled bone scintigraphy or biopsy. A random-effects proportional meta-analysis was conducted to estimate the pooled prevalence and assess geographic, subtype, sex-based, and study design-related differences. Twenty-eight studies encompassing 7,393 HF patients were included, of whom 627 were diagnosed with CA. The pooled prevalence of CA among HF patients was 10% (95% CI, 7%-13%), with substantial heterogeneity (prediction interval, 2-41%). Prevalence varied by region, ranging from 6% in North America to 15% in Asia, though subgroup differences were not statistically significant. Wild-type transthyretin amyloidosis (ATTRwt-CA) accounted for the majority of cases, representing 76% (95% CI, 57%-89%) of CA diagnoses and a pooled prevalence of 11% among screened populations. Approximately 24% of CA cases occurred in females. In conclusion, CA is present in one in ten patients with HF worldwide, with ATTRwt-CA being the predominant subtype. Uneven geographic distribution may suggest underdiagnosis, particularly in underrepresented regions and in females. Standardized, multinational studies are needed to define the global burden of CA better and guide equitable screening strategies.