Comprehensive Geriatric Assessment to Optimize the Management of Older Patients With Transthyretin Cardiac Amyloidosis

Abstract

Transthyretin cardiac amyloidosis (ATTR-CA) predominantly affects older adults with multiple chronic conditions, leading to significant physical, cognitive, and emotional challenges. New disease-modifying drugs are effective in early stages, prompting a shift toward comprehensive assessments, including functional capacity and quality of life. However, these assessments may not fully capture the complexity of older ATTR-CA patients, especially regarding frailty and mood disorders, which can influence symptom reporting. Thus, integrating comprehensive geriatric assessment tools into routine clinical practice may be crucial to detect early signs of frailty or functional impairment that could impact outcomes and mitigate futility and ageism in the decision-making process. This review highlights the importance of evaluating multimorbidity, disability, and frailty in older patients with ATTR-CA to optimize management strategies.

Central Illustration

Highlights

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  Patients with ATTR-CA are almost exclusively older adults at diagnosis with multiple chronic conditions.

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  A routine CGA is useful to delineate the clinical complexity (ie geriatric syndromes) of older ATTR-CA patients.

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  A CGA that incorporates the expertise of geriatricians, cardiologists, neurologists, palliative care specialists, and others may help reduce ageism and futility and could be integrated in future clinical trials.