Heart failure & cardiomyopathiesCohort study
Tafamidis in women with wild-type transthyretin cardiac amyloidosis: an international cohort study
- international, multicentric cohort
- propensity score-matched
Authors' conclusion
Women with ATTRwt-CM are prone to underdiagnosis and undertreatment, despite similar poor natural course and tafamidis treatment efficacy. Initiatives to increase diagnostic awareness and disease modifying treatment initiation in women are urgently needed.
Study context
- Population
- Patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM)307 (21.1%) females, mean age 81 ± 7y
- Participants
- 1,454 patients
- Exposure
- Sex-differences in clinical presentation, natural course, and tafamidis treatment efficacy
- Tafamidisn = 1,055
- Femalesn = 307
Main finding
As reported in the abstract
females were ∼3 years older than males with slightly worse phenotype, including higher indexed left ventricular wall thickness and National Amyloidosis Centre (NAC) disease stage
P < 0.050
Heart failure with preserved ejection fraction and hypertension coincided more often in women
P = 0.001
Observational data: associations, not effects.
Further findings
All-cause mortality · 1.9 (0.9-3.3) years of median follow-up
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| Tafamidis · propensity score-matched cohort (n = 742) | 0.44 (0.32–0.61) | P < 0.001 | |
| Tafamidis (female) · female | 0.76 (0.52–1.11) | P = 0.150 | |
| 0.20.5125Hazard ratio (log scale) |
Mortality under tafamidis treatment, predictors
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| NAC disease stages | 2.13% (1.81–2.50) | P < 0.001 | |
| female sex | 0.82 (0.53–1.27) | P = 0.365 | |
| 0.512Hazard ratio (log scale) |
- All-cause mortality — patients died
- 409 (28.1%)
- All-cause mortality: sex-based treatment efficacy interaction P = 0.381
Natural disease course by sex
- poor without sex-difference, even when age-corrected
- P = 0.210
Tafamidis initiation
- Tafamidis initiated, 12% less in females
- 1055
- sex difference in initiation
- P < 0.001
- reasons for non-initiation by sex
- P = 0.116
- reasons for discontinuation by sex
- P = 0.304
Original publication
Summarised from the published abstract; every number is checked against it