Older age alone does not contribute to poorer outcomes in patients with transthyretin amyloid cardiomyopathy (ATTR-CM), yet older patients are less likely to receive disease-modifying therapies, according to a study recently published in Circulation: Heart Failure. This suggests that agism may impact the care that older patients receive.
Ageism in medicine manifests as the withholding of treatment based on age alone, independent of additional evidence-based criteria. Researchers sought to identify if age played a disproportionate role in clinical decision-making regarding the prescription of disease-modifying therapies in ATTR-CM. They conducted a comprehensive geriatric assessment (CGA) on 256 patients who were diagnosed with ATTR-CM between March 2021 and March 2024.
The CGA included screening for both physical and mental health, encompassing frailty, cognitive impairment, nutritional status, treatment history and disability. In addition, patients underwent a comprehensive heart health assessment.
Read more about ATTR-CM testing and diagnosis
Researchers found that patients who were 85 years of age and above were significantly less likely to receive disease-modifying therapies. This was true even after they took into account common age-related factors such as disability, frailty and cumulative deficits (i.e., the sum of individual CGA item scores).
A total of 45 patients (17.6%) died over the course of 1.9 years. Of the 29 patients (64.4%) with an identified cause of death, only 18 were related to the heart. While certain factors associated with advanced age (particularly frailty, nutritional status and disability) increased the risk of death among patients with ATTR-CM, age alone did not.
“Rather than relying on chronological age, clinicians should assess frailty and functional status to inform treatment decisions and improve care equity in older patients with cardiac amyloidosis,” the study’s authors noted.
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