Wild-type transthyretin cardiac amyloidosis: the need for a comprehensive geriatric assessment beyond age

Wild type transthyretin cardiac amyloidosis (wtATTR-CM) is an age-related condition which results from the deposition of insoluble amyloid fibrils, formed by the misfolding of transthyretin, a protein produced by the liver. It is a progressive disease if left untreated. The improvement in non-invasive diagnostic pathways, coupled with raised disease awareness and the recognition of wtATTR-CM as a treatable condition, has been associated with an exponential increase in the diagnosis especially in patients over 80-year-old - an underrepresented category in clinical trials. Recent evidence suggests that while some octogenarians may gain benefit from disease-specific therapy, others do not respond. For this reason, in octogenarians the key future challenge will be to validate objective tools to identify patients who are unlikely to benefit from disease modifying treatment and at the same time not to discriminate patients simply on chronological age, with the overall aim to identify those patients who may gain most benefit from intervention.