SPC365

Decoding the Decades: Tafamidis Efficacy Across Different Age Groups in ATTR-CM patients

Session: SESSÃO DE COMUNICAÇÕES ORAIS 06 – EXPLORANDO A AMILOIDOSE CARDÍACA: INOVAÇÕES NO DIAGNÓSTICO, PROGNÓSTICO E TRATAMENTO
Speaker: Catarina Gregório

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 17. Myocardial Disease
Subtheme: 17.4 Myocardial Disease – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Catarina Gregório; Ana Abrantes; Miguel Raposo; João Fonseca; Marta Vilela; Diogo Ferreira; João Cravo; Catarina Campos; Isabel Conceição; Fausto J. Pinto; Dulce Brito; João R. Agostinho

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a severe condition primarily affecting elderly patients (pts), leading to heart failure (HF) and increased mortality. In a sub-analysis of ATTR-ACT, tafamidis 61mg demonstrated efficacy for pts with ATTR-CM both in those aged &lt;80 and those aged &ge;80 years, improving quality of life and functional capacity. However, it remains unclear whether the efficacy of tafamidis varies significantly among different age subgroups within the elderly population.&nbsp;</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: To assess the impact of tafamidis 61mg in ATTR-CM pts aged &lt;75, 75-85, and &gt;85 years.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Single-center retrospective study of ATTR-CM pts, categorized into 3 groups based on age: &lt;75, 75-85, and &gt;85 years. Clinical, laboratory, and echocardiographic parameters were collected. Kaplan-Meier survival analysis was used to compare the composite endpoint of HF hospitalization and cardiovascular (CV) death.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: 89 pts with ATTR-CM were included (&lt;75 years: 23 pts; 75&ndash;85 years: 40 pts; &gt;85 years: 26 pts). Patients &lt;75 years had a significantly higher prevalence of hereditary ATTR-CM (p&lt;0.001). Effort dyspnea was the predominant initial symptom in the 75&ndash;85 and &gt;85-year subgroups (p=0.002), whereas younger pts more commonly presented with carpal tunnel syndrome (p=0.04) or sensory-motor polyneuropathy (p=0.001). Older pts (75&ndash;85 and &gt;85 years) were predominantly in NYHA class II/III (p=0.009) and required higher diuretic doses (p=0.08), while younger pts showed better functional capacity, with a higher proportion in NYHA class I (p&lt;0.001). NT-proBNP levels were significantly higher in pts &gt;75 years (p&lt;0.001). At baseline, groups were comparable in LVEF and LV hypertrophy (p=NS), but global longitudinal strain was more impaired in pts &gt;85 years (&lt;75: -21.7&plusmn;0.8, 75&ndash;85: -14.5&plusmn;1.1, &gt;85: -10.1&plusmn;2.3; p=0.039) &ndash; Table 1.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">During a follow-up period of 24.9&plusmn;2.1 months, tafamidis treatment in pts aged &gt;85 years was associated with a greater reduction in NT-proBNP compared to the other 2 groups (p=0.041) and a reduction in diuretic doses compared to pts aged &lt;75 years (p=0.044). However, no improvement in NYHA functional class (p=NS) or significant differences in KCCQ score were observed across the groups at follow-up (p=NS). Echocardiographic parameters remained comparable among all groups throughout the study. Similarly, the composite endpoint of HF hospitalizations and CV death showed no statistically significant differences between groups during follow-up (LogRank 5.71, p=0.06 &ndash; Figure 1). A sub-analysis of pts aged &ge;90 years (all with ATTRwt) revealed outcomes consistent with the overall population, emphasizing that this very elderly subgroup also benefits from tafamidis therapy.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: This study highlights the benefits of tafamidis in elderly pts, including those &ge;85 years, and supports its use in all age groups to improve cardiovascular outcomes in ATTR-CM.</span></span></span></p>