Frailty, Disability, and Malnutrition Assessment for Preventive Measure in Transthyretin Cardiac Amyloidosis

The prevalence of transthyretin cardiac amyloidosis (ATTR-CA) among older adults is increasing. Whether age and geriatric syndromes bear any impact on the management and outcomes in ATTR-CA is poorly understood. In a prospective, multicenter cohort study, 256 patients diagnosed with ATTR-CA from 03/2021 to 03/2024 underwent comprehensive geriatric assessment (CGA). The study evaluated the prevalence and clinical associations of CGAs across different disease stages (National Amyloidosis Centre (NAC) stage). Key CGA domains included disability, malnutrition, depression, frailty, short physical performance battery (SPPB) and cumulative deficits (sum of the single CGA items). Associations of these measures with disease modifying therapy and overall mortality were analyzed. Median age was 82 years (men: 87%, variant: 19,7.4%); 129 (50.3%) patients received disease-modifiers. Those >85 years had significantly lower odds of receiving disease modifying therapy even after adjusting for disability, frailty, and cumulative deficits. Over 1.7 [interquartile range 1.0-2.1] years, 44 (17.2%) patients died. After adjustment for NAC stage, diuretics and diseasemodifiers, CGA domains of disability, malnutrition, SPPB, frailty and number of deficits, but not age, were significantly associated with mortality. Assessment of CGA domains improved NAC prognostic accuracy. In a national prospective cohort of ATTR-CA patients, older age was associated with lower prescription of disease-modifiers, even among individuals with a low burden of geriatric syndromes. However, when adjusted for geriatric domains, age was not associated with survival, indicating potential ageism. Since some geriatric syndromes may be modifiable, a CGA could enhance risk stratification, reduce age-related bias, and improve outcomes.