Frailty is a mortality risk factor in tafamidis-treated patients with transthyretin cardiac amyloidosis

ATTR-CM is a multisystemic disease whose prevalence increases with age and contributes to the development of frailty. However, the prognostic value of frailty assessment in ATTR-CM remains poorly documented. We evaluated whether frailty assessed using the Short Emergency Geriatric Assessment (SEGA) questionnaire independently predicts mortality in patients with ATTR-CM treated with tafamidis.

We conducted a prospective study of patients consulting at the French Reference Center for Cardiac Amyloidosis between November 2018 and January 2021. Frailty was assessed using Part A of the SEGA score. Cox regression models evaluated the association between frailty and mortality.

A total of 410 patients with ATTR-CM were included (79% wild-type ATTR). Median age [IQR] was 81 [75-85] years and 21% were frail or very frail (SEGA score >8). Median follow-up was 2.3 years [1.7-3.1]. Frail patients had higher mortality than robust patients (36% vs 24%, p = 0.01). In multivariable analysis, frailty remained independently associated with mortality (HR 1.85, 95% CI 1.13-3.01). The inclusion of frailty improved model discrimination. Among SEGA domains, older age, need for assistance at home, and impaired functional and motor independence were significantly associated with mortality.

Frailty assessed using the SEGA independently predicts mortality in ATTR-CM patients treated with tafamidis and improves prognostic stratification. It may also help identify potentially modifiable vulnerabilities warranting personalized multidisciplinary care.