Heart failure & cardiomyopathiesCohort study
Tafamidis in octogenarians with wild-type transthyretin cardiac amyloidosis: an international cohort study
- Multicentre cohort study
- international
- consecutive patients
- propensity-score matched
Authors' conclusion
Real-world tafamidis treatment improves survival without age affecting treatment efficacy, although mortality remains considerable in octogenarians.
Study context
- Population
- Wild-type transthyretin cardiomyopathy patients, including octogenarians (≥80 years)415 octogenarians
- Participants
- 710 patients
- Exposure
- Tafamidis vs no tafamidis
- Outcome
- All-cause mortality
- Follow-up
- Mean 2.2 ± 1.8 years
Main finding
As reported in the abstract
Tafamidis vs UntreatedHazard ratio (95% CI)P value
propensity score matched, on average 394 subjects
0.53(0.34–0.84)
P = 0.007octogenarians, propensity score matched
0.57(0.33–1.01)
P = 0.053Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Mortality despite tafamidis in octogenarians (subgroups) — Initiated at ≥90 years vs Untreated | 3.3 (1.10–9.53) | P = 0.033 | |
| Mortality despite tafamidis in octogenarians (subgroups) — National Amyloidosis Centre Stage ≥3 vs Untreated | 2.4 (0.87–6.46) | P = 0.090 | |
| 0.10.31310Hazard ratio (log scale) |
| Outcome | Tafamidis | Untreated | Estimate | P value |
|---|---|---|---|---|
| Unadjusted survival, treated vs untreated octogenarians | ||||
| 1-year mortality | 5% | Not reported in the abstract | ||
| 3-year mortality | 24% | Not reported in the abstract |
- Unadjusted survival, treated vs untreated octogenarians — Better unadjusted survival with tafamidis
- P < .001
- Natural course before tafamidis availability: mortality, octogenarians vs non-octogenarians: Octogenarians 1-year mortality 16% · 5-year mortality 71%
- Natural course before tafamidis availability: mortality, octogenarians vs non-octogenarians: Non-octogenarians 1-year mortality 8% · 5-year mortality 47%
- Natural course before tafamidis availability: mortality, octogenarians vs non-octogenarians: P < .001
- Tafamidis initiation since availability: Octogenarians 70.1%
- Tafamidis initiation since availability: Non-octogenarians 83.7%
- Tafamidis initiation since availability: P < .001
- Tafamidis discontinuation: Octogenarians 10.3%
- Tafamidis discontinuation: Non-octogenarians 7.4%
- Tafamidis discontinuation: P = .260
Interaction of age with tafamidis mortality benefit
- No interaction with age at diagnosis
- P = 0.217
- No interaction with age at treatment initiation
- P = 0.154
Original publication
Tafamidis in octogenarians with wild-type transthyretin cardiac amyloidosis: an international cohort study. Eur Heart J. Published 26 February 2025. doi:10.1093/eurheartj/ehae923
Summarised from the published abstract; every number is checked against it