Key result
Comprehensive geriatric assessment complements cardiac staging in ATTR-CM, where ~66% of patients present with frailty.
Why the study?
Available disease-modifying therapies for ATTR-CM are costly and require 12 to 18 months for clinical benefit, while frailty in these older adults is associated with poorer outcomes yet is not captured by current cardiac prognostic staging systems.
Does integrating Comprehensive Geriatric Assessment and frailty evaluation into routine cardiac care improve personalized disease-modifying therapy decision-making and targeted interventions in older adults with transthyretin amyloid cardiomyopathy?
Does integrating Comprehensive Geriatric Assessment and frailty evaluation into routine cardiac care improve personalized disease-modifying therapy decision-making and targeted interventions in older adults with transthyretin amyloid cardiomyopathy?
Integrating Comprehensive Geriatric Assessment alongside cardiac staging in older patients with ATTR-CM helps identify modifiable geriatric vulnerabilities and supports individualized decision-making for costly disease-modifying therapies.
Answers are grounded in this paper and cite their sources.
May support integrating frailty assessment into ATTR-CM care for personalized therapy decisions; hypothesis-generating and requires prospective validation before adoption.
Transthyretin amyloid cardiomyopathy (ATTR-CM), once considered a rare disease, is now an increasingly recognized cause of heart failure. This rise in diagnoses is driven by increased awareness, the availability of non-invasive diagnostics, and the introduction of disease-modifying therapies (DMTs) in an aging population. Available DMTs are costly and may require 12 to 18 months before clinical benefit becomes apparent, making careful assessment of expected treatment benefit essential. Because ATTR-CM predominantly affects older adults, frailty, multimorbidity, and competing health risks are common. Frailty is associated with poorer outcomes and reduced quality of life, yet is not captured by current prognostic staging systems, which primarily reflect cardiac disease severity. Frailty assessment may complement cardiac evaluation by supporting personalized DMT decision-making and identifying modifiable vulnerabilities for targeted interventions. This narrative review integrates cardiology and geriatric perspectives to examine the role of Comprehensive Geriatric Assessment, including frailty assessment, in ATTR-CM. Evidence on frailty prevalence, prognostic significance, and the concept of a disease-specific frailty phenotype is summarized. The role and key components of the CGA are outlined. Additionally, a multidisciplinary care pathway incorporating CGA into clinical practice is proposed to support personalized DMT decisions and targeted interventions.
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Heide et al. (2026) conducted a review in Transthyretin amyloid cardiomyopathy (ATTR-CM). Comprehensive Geriatric Assessment (CGA) and frailty assessment was evaluated. Comprehensive geriatric assessment and frailty evaluation in ATTR-CM patients complement cardiac staging (pooled frailty prevalence 66%) to guide personalized disease-modifying therapy decisions.
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