Prevalence, clinical implications and prognostic impact of frailty and other geriatric conditions in patients with transthyretin amyloid cardiomyopathy.
Abstract
INTRODUCTION AND
Objectives
Frailty in transthyretin amyloid cardiomyopathy (ATTR-CM) remains poorly characterized. The aim of this study was to analyze the prevalence and prognostic influence of frailty and other geriatric conditions such as nutritional risk, cognitive status, depression, and dependence in patients with ATTR-CM.
Methods
We performed an observational, prospective, single-center study of 110 ATTR-CM patients who underwent comprehensive geriatric assessment from October 2024 to April 2025 and were followed up to September 2026. Study endpoints were all-cause death and the combined event of all-cause death or worsening heart failure. Outcomes were assessed by the Kaplan-Meier method and multivariable Cox regression.
Results
The prevalence of frailty, based on 4 different criteria, varied from 32.7% to 62.7%. Dependence, depression, nutritional risk, and cognitive impairment were detected in up to 70.9%, 29.1%, 27.3%, and 15.5% of patients, respectively. Frailty, defined as a Clinical Frailty Scale > 4, a Survey of Health, Ageing and Retirement in Europe-Frailty Instrument > 2, or a Short Physical Performance Battery < 10, was independently associated with an increased risk of both study outcomes. Dependence (Katz index < 6) and cognitive impairment (Mini Examen Cognitivo score < 23) were also independent predictors of both outcomes. Frailty diagnosis showed incremental prognostic value when added to United Kingdom National Amyloidosis Centre stages.
Conclusions
Frailty is frequent in patients with ATTR-CM and is associated with impaired clinical outcomes.