Three aspects of frailty — older age, needing help at home and having less ability to independently do daily tasks — are linked to increased mortality in people with transthyretin amyloid cardiomyopathy (ATTR-CM), according to a study published recently in Amyloid: The Journal of Protein Folding Disorders.
“Beyond the severity of cardiac involvement, the prognosis of patients with ATTR-CM appears to be influenced by a broader frailty phenotype reflecting the multisystem nature of transthyretin amyloidosis and its extracardiac manifestations,” the study’s authors said.
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The prospective study included 410 patients treated at the French Reference Center for Cardiac Amyloidosis between November 2018 and January 2021. Most were taking tafamidis.
Overall, 86 of the patients (21%) were considered frail or very frail based on having a Short Emergency Geriatric Assessment score greater than 8. The Short Emergency Geriatric Assessment assessment considers multiple aspects of health, including mobility, independence, nutrition, continence, medications and other medical conditions.
Read more about ATTR-CM prognosis and staging
During the study period, 26% of patients had died by three years. Mortality was higher among frail patients than those considered robust: 36% of frail patients died, compared with 24% of robust patients.
However, acute heart failure hospitalizations occurred at similar rates between the two groups, affecting 33% of frail patients and 31% of robust patients.
Frailty remained independently associated with mortality even after researchers accounted for other factors. Patients classified as frail had an 85% higher risk of death than robust patients. Adding frailty to the risk model also improved its ability to distinguish patients with different levels of mortality risk.
The researchers said frailty assessment may serve not only as a way to estimate prognosis but also as a tool for identifying potentially modifiable problems that could be addressed through personalized, multidisciplinary care.
“Integrating frailty screening into routine clinical practice may improve the care pathway by encouraging closer collaboration between cardiologists and geriatricians and enabling more multidisciplinary personalized management strategies, with the potential to improve quality of life, survival, and the preservation of functional independence,” the authors said.
For patients, the findings suggest that ATTR-CM care may need to consider more than heart function alone. Identifying difficulties with walking, daily activities, nutrition or living independently could help clinicians connect patients with appropriate support.
