Efficacy of tafamidis across age groups in ATTR-CM: insights from real-world data

INTRODUCTION: Elderly patients with transthyretin amyloid cardiomyopathy (ATTR-CM) remain underrepresented in clinical trials. This study aimed to evaluate the effectiveness of tafamidis 61 mg in patients with ATTR-CM across different age groups. MATERIAL AND METHODS: Patients with ATTR-CM treated with tafamidis 61 mg were stratified into age groups: < 75, 75-85, > 85 years. Clinical and echocardiographic data were collected at baseline and follow-up. The primary outcome - cardiovascular-related hospitalization and cardiovascular death - was assessed using Kaplan-Meier analysis. RESULTS: A total of 89 patients with ATTR-CM were included: < 75 (n = 23), 75-85 (n = 40), and > 85 years (n = 26). Hereditary ATTR-CM was more prevalent in younger patients (p < 0.001). Older patients (≥ 75) were more often in NYHA class II/III (p = 0.009), required higher diuretic doses (p < 0.001), and had higher NT-proBNP (p = 0.002). At baseline, patients ≥ 75 years had greater maximal wall thickness (p < 0.001) and left ventricular mass (p = 0.034); global longitudinal strain was most impaired in those > 85 years (p = 0.039). Over a mean follow-up time of 27.4 ± 19.3 months, tafamidis treatment in patients > 85 years was associated with a greater reduction in NT-proBNP (p = 0.041) and in diuretic doses compared to those < 75 years (p = 0.044). No significant changes were observed in NYHA class, Kansas City Cardiomyopathy Questionnaire scores, or echocardiographic parameters. The composite outcome of cardiovascular-related hospitalization and cardiovascular death did not differ significantly among age groups (Log-Rank 5.71, p = 0.06). CONCLUSIONS: This study underscores the benefits of tafamidis in elderly patients, including those aged > 85 years, and supports its use across all age groups to improve cardiovascular outcomes in ATTR-CM.