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February 6, 2026European Heart Journal

The relevant role of frailty in patients with transthyretin amyloidosis cardiomyopathy

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Why the study?

Frailty assessment in transthyretin cardiac amyloidosis is poorly explored, and standardized tools for its evaluation in this setting are lacking.

Does frailty, assessed by the Clinical Frailty Scale or hand-grip strength, predict death and heart failure hospitalization in older patients with transthyretin cardiac amyloidosis?

Population

107 patients over 65 years with confirmed TTR-CA

Comparison

Frailty assessed by Clinical Frailty Scale (CFS) and hand-grip strength (HGS)

Design

Prospective observational cohort study

Follow-up

Median 16 months

Key result

A Clinical Frailty Scale score ≥5 independently predicted death and heart failure hospitalization in patients with transthyretin cardiac amyloidosis (HR 2.87; 95% CI 1.11-7.41; p=0.029).

Authors

BPBeatrice Dal PassoMAMatteo ArzentonJBJacopo Bonini

Discussion

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Overview

May refine risk stratification in TTR-CA; leaves open whether frailty assessment should guide care.

Key Points

  • The aim is to evaluate the prevalence and prognostic value of frailty in patients with transthyretin cardiac amyloidosis.
  • Prospective data collection at a Cardiac Amyloidosis Center.
  • Focused on patients over 65 with confirmed TTR-CA diagnosis.
  • Comprehensive evaluations including echocardiography, biomarker sampling, NAC staging, and frailty assessment (CFS and HGS).
  • Frail patients defined as CFS≥5 and assessed using hand-grip strength cut-offs.
  • Out of 107 subjects, 14% were classified as frail using CFS.
  • Frail patients exhibited significantly lower hand-grip strength and higher median CFS scores compared to non-frail patients.
  • The composite outcome of death and HF hospitalization occurred in 22% of the patients observed, with frail patients having a significantly higher risk.
  • CFS≥5 was identified as an independent predictor of adverse outcomes, with an HR of 2.87 in multivariate analysis.

Study Design

Type

Cohort (n=107)

Multicenter

No

Structured PICO

Does frailty, assessed by the Clinical Frailty Scale or hand-grip strength, predict death and heart failure hospitalization in older patients with transthyretin cardiac amyloidosis?

P
Population
107 patients over 65 years with a confirmed diagnosis of transthyretin cardiac amyloidosis (TTR-CA), including 81 with wild-type TTR-CA, median age 80.3 years.
I
Intervention
Frailty, defined as Clinical Frailty Scale (CFS) ≥5 or low hand-grip strength (HGS <30 kg for males, <20 kg for females)
C
Comparator
Non-frail patients (CFS <5 or normal hand-grip strength)
O
Outcome
Composite outcome of death and heart failure hospitalizationcomposite

Main Result

Effect estimate: HR 2.87 (95% CI 1.11-7.41)

Absolute Event Rate: 71% vs 14%

p-value: p=0.029

Frailty, assessed by the Clinical Frailty Scale, is a significant independent predictor of mortality and heart failure hospitalization in older patients with transthyretin cardiac amyloidosis.

Cite This Study

Passo et al. (2025) conducted a cohort in Transthyretin cardiac amyloidosis (TTR-CA) (n=107). Clinical Frailty Scale (CFS) ≥5 vs. CFS <5 was evaluated on Composite of death and heart failure hospitalization (HR 2.87, 95% CI 1.11-7.41, p=0.029). A Clinical Frailty Scale score ≥5 independently predicted death and heart failure hospitalization in patients with transthyretin cardiac amyloidosis (HR 2.87; 95% CI 1.11-7.41; p=0.029).

synapsesocial.com/papers/698586118f7c464f23009f7ahttps://doi.org/10.1093/eurheartj/ehaf784.1439
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