The Weight of Comorbidities in the Specific Treatment of ATTR-Related Amyloid Cardiomyopathy

TL;DR

This review discusses how to manage heart failure and comorbidities in patients with transthyretin amyloid cardiomyopathy, emphasizing the need for tailored treatment strategies.

Contribution

The paper highlights the importance of integrating comorbidity care into the treatment of ATTR-CM for improved patient outcomes.

Findings

ATTR-CM is now more commonly diagnosed due to increased awareness and non-invasive diagnostic methods.

Patients with ATTR-CM often have multiple comorbidities, which may affect treatment response and outcomes.

Earlier diagnosis and real-world evidence are crucial for improving prognosis and guiding future research.

Abstract

This review aims to provide an updated overview of the clinical management of heart failure and comorbidities in transthyretin amyloid cardiomyopathy (ATTR-CM). We sought to address key unanswered questions and current uncertainties regarding treatment response, prognosis, and optimization of care in this complex population.

Once considered rare, ATTR-CM is now increasingly recognized due to greater awareness and the possibility of non-invasive diagnosis. Patients are often identified at earlier stages, with lower mortality than historically observed. Disease-modifying therapies with proven efficacy in randomized trials are now available, yet many patients experience disease progression. In real-world practice, ATTR-CM patients are typically older and have multiple cardiac and extracardiac comorbidities, often representing exclusion criteria of clinical trials, which may influence treatment response and efficacy.

Modern management of ATTR-CM should integrate heart failure treatment with tailored approaches to comorbidity care. Earlier diagnosis, real-world evidence, and strategies for patients outside trial populations will be essential to improve prognosis and guide future research.

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