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Outcomes of Octogenarian Patients Treated with Tafamidis for Transthyretin Amyloid Cardiomyopathy
Abdullah Sarkar1, Alejandro Sanchez-Nadales1, Setor K Kunutsor2
1Robert and Suzanne Tomsich Department of Cardiovascular Disease, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, Weston, Florida.
Insights
Tafamidis treatment shows similar survival benefits for elderly (≥80 years) and younger (<80 years) patients with transthyretin amyloid cardiomyopathy (ATTR-CM). This finding supports its use across different age groups for this condition.
Area of Science:
- Cardiology
- Pharmacology
- Geriatrics
Background:
- Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive condition impacting cardiac function.
- Tafamidis is an established disease-modifying agent for ATTR-CM, improving patient survival.
- The survival impact of tafamidis in elderly patients (≥80 years) with ATTR-CM remains under-investigated.
Purpose of the Study:
- To evaluate and compare the survival outcomes of elderly (≥80 years) and younger (<80 years) patients with ATTR-CM treated with tafamidis.
- To determine if age influences the efficacy of tafamidis in reducing mortality in ATTR-CM patients.
Main Methods:
- Retrospective analysis of 484 ATTR-CM patients treated with tafamidis (diagnosed between 2008-2021).
- Patients were stratified into two groups: aged ≥80 years (n=208) and aged <80 years (n=276).
- Mortality outcomes were assessed using Kaplan-Meier curves and multivariable Cox proportional hazards models.
Main Results:
- No significant difference in survival probability was observed between the elderly and younger groups at 30 months (p=0.76).
- Five-year survival rates were comparable: 38.5% for ≥80 years vs. 64.6% for <80 years.
- Multivariable analysis revealed a hazard ratio of 0.81 (95% CI: 0.41-1.61) for mortality in the ≥80 years group compared to the <80 years group, indicating similar risk.
Conclusions:
- Tafamidis treatment demonstrates comparable survival benefits for both elderly (≥80 years) and younger (<80 years) patients diagnosed with ATTR-CM.
- The findings support the use of tafamidis as an effective therapeutic option across a wide age spectrum in ATTR-CM management.
- Age does not appear to be a significant factor in the mortality reduction achieved by tafamidis therapy in ATTR-CM.
Abstract:
Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) benefit from disease-modifying agents such as tafamidis. However, the survival benefit of tafamidis in elderly patients (age ≥80 years) is not reported. This study aimed to assess the survival of patients with ATTR-CM aged 80 years and older who were treated with tafamidis compared with patients aged <80 years. We conducted a retrospective analysis of patients with ATTR-CM who underwent tafamidis treatment, aged 45 to 97 years at the time of diagnosis between January 1, 2008, and May 31, 2021. A total of 484 patients were included, with 208 in the ≥80 years group and 276 in the <80 years group. The cohort was followed up for mortality outcomes, and hazard ratios with 95% confidence intervals were calculated. After a median follow-up of 18.5 months, 72 deaths were recorded in the entire cohort. Kaplan-Meier curves showed no differences in survival probability between the 2 groups at 30 months (p for log-rank test = 0.76). The survival rates for patients aged ≥80 years who underwent treatment at 1, 2, 3, 4, and 5 years were 94.7%, 86.0%, 77.0%, 77.0%, and 38.5%, respectively. The corresponding rates for patients aged <80 years who underwent treatment were 93.2, 84.8, 74.4, 68.2, and 64.6%, respectively. In the multivariable analysis, the hazard ratio (95% confidence interval) of the mortality comparing treatment patients aged ≥80 years with those aged <80 years was 0.81 (0.41 to 1.61). In conclusion, tafamidis treatment is associated with similar reductions in mortality in older and younger patients with ATTR-CM.
