Tafamidis Reduces Death and Hospitalization for Acute Heart Failure in Octogenarian Patients With Transthyretin Cardiac Amyloidosis: A Propensity Score-Weighted Cohort Study.

BACKGROUND: Transthyretin cardiac amyloidosis results from the deposition of misfolded amyloid fibrils in cardiac tissue, leading to progressive heart failure. Tafamidis, a transthyretin stabilizer, reduces all-cause death and cardiovascular rehospitalization, but its impact on people aged ≥80 years remains underexplored. This study evaluated the effectiveness of tafamidis in octogenarian patients with transthyretin cardiac amyloidosis compared with nonexposed patients. METHODS: A propensity score-weighted cohort study included all patients aged ≥80 years with confirmed transthyretin cardiac amyloidosis (hereditary or wild-type) followed at the French Referral Center for cardiac amyloidosis between 2010 and 2021. Patients who initiated tafamidis after November 1, 2018, and were treated for at least 24 months were included in the tafamidis group, whereas patients diagnosed between March 18, 2010, and November 1, 2018, who did not receive tafamidis were included in the nonexposed group. The primary outcome was 24-month all-cause death, and the secondary outcomes were hospital readmission for acute heart failure at 12 months and the causes of death. RESULTS: Between March 18, 2010, and July 5, 2021, 465 patients were included. After inverse probability of treatment weighting, tafamidis treatment was found to be associated with a relative reduction of 56% in the 24-month mortality rate (hazard ratio [HR], [95% CI, 0.44 0.35-0.57]; P<0.001) and a relative reduction of 35% in the frequency of 12-month hospital readmissions for acute heart failure (HR, 0.65 [95% CI, 0.48-0.90]; P=0.008). The difference in the cardiovascular death rate was not significant. CONCLUSIONS: Tafamidis led to a lower mortality rate and fewer hospital readmissions for acute heart failure in octogenarian patients with transthyretin cardiac amyloidosis.