Non-amyloid specific treatment for transthyretin cardiac amyloidosis: a clinical consensus statement of the ESC Heart Failure Association

This clinical consensus statement, developed by the Heart Failure Association of the European Society of Cardiology, offers a detailed review of the non-specific management of transthyretin amyloid cardiomyopathy (ATTR-CM). This progressive and often fatal condition is increasingly recognized as a major contributor to heart failure. This document provides advice on symptom management and enhancing quality of life, with a focus on volume management, neurohormonal modulation, and tailored use of diuretics and other supportive therapies that address the distinct pathophysiology of ATTR-CM. It also explores advanced treatment modalities such as heart transplantation and mechanical circulatory support, which play crucial roles in managing advanced stages of the disease. Furthermore, it addresses the management of aortic stenosis in the context of ATTR-CM, advising transcatheter aortic valve replacement as the preferred treatment for these patients. The advice provided in this document relies primarily on expert opinion and retrospective studies due to a notable lack of randomized clinical trials, which underscores a critical research gap and the pressing need for evidence-based treatment protocols.