Abstract Background and Aims Cardiac transthyretin amyloidosis (ATTR-CM) is a lifethreatening cardiomyopathy. Tafamidis has been demonstrated to be an effective treatment. The impact on the elderly remains debated. Our aim was to analyze clinical characteristics and survival of patients with ATTR-CM aged ≥80 years diagnosed after November 2018, treated with tafamidis 80/61 mg, and compare them with a nontreated group diagnosed before that date. Methods Data from the two groups were extracted from the Healthcare European Amyloidosis Registry (HEAR) and analyzed according to age subgroups (80-85 vs 85 years) and heart failure severity (NYHA I-II vs III-IV). Results Out of 1380 patients, 1194 were treated with tafamidis 80/61 mg, while 186 were not treated. Treated patients were significantly less severe at baseline, with a lower occurrence of NYHA class III-IV compared to the untreated group (24 vs. 46%, p0.001). The median NT-proBNP at baseline was lower in the treated group (2330 vs. 4854 pg/ml, p0.001), as was the average level of high-sensitivity troponin T (55 vs. 74 ng/ml, p0.001), and the interventricular septal thickness (16 vs. 18 mm, p0.001). The 3-year survival rate for treated patients was 57%, and 40% for untreated patients. In the treated group, the 3-year survival rate was 68% for patients aged 80–85 years and 58% for those over 85 years. Survival rates were confirmed after propensity score analyses. Conclusions Survival in ATTR-CM patients has significantly improved in the recent period, both because of earlier diagnosis and because of tafamidis treatment, even in elderly patients.Graphical abstract
Jobbe-Duval et al. (Sat,) studied this question.