[Amyloidosis in the elderly: a clinical enigma between frailty and diagnosis]

Cardiac amyloidosis is considered a rare disease but is increasingly frequent in elderly patients. In these patients, heterogeneous and peculiar clinical manifestations require specific approaches and dedicated diagnostic-therapeutic pathways. Early diagnosis is important because mortality is high, and the disease is often latent and underdiagnosed. In particular, the light chain form represents a real emergency, due to the rapidly fatal course in the absence of treatment. Specific programs based on a multispecialist approach should be implemented to reduce delays in diagnosis. Thanks to these programs, in recent years patients are often diagnosed at an early stage with a reduction in mortality. In the elderly, health status does not only depend on the disease or age, but also on factors such as frailty, comorbidity, living conditions and psychological factors. In these patients, a pragmatic approach should include a frailty screening using simple and easy-to-use tools. The therapeutic approach in the elderly has the dual objective of treating symptoms and complications of the disease and modifying the course of the disease and slowing its progression with specific therapies. In the context of a universalistic health system such as the Italian one, the introduction of highly innovative, but also expensive, therapies raises significant questions in terms of economic sustainability, accessibility of care and protection of patients' dignity.