Frailty is a mortality risk factor in tafamidis-treated patients with transthyretin cardiac amyloidosis.

BACKGROUND: ATTR-CM is a multisystemic disease whose prevalence increases with age and contributes to the development of frailty. However, the prognostic value of frailty assessment in ATTR-CM remains poorly documented. We evaluated whether frailty assessed using the Short Emergency Geriatric Assessment (SEGA) questionnaire independently predicts mortality in patients with ATTR-CM treated with tafamidis. METHODS: We conducted a prospective study of patients consulting at the French Reference Center for Cardiac Amyloidosis between November 2018 and January 2021. Frailty was assessed using Part A of the SEGA score. Cox regression models evaluated the association between frailty and mortality. RESULTS: A total of 410 patients with ATTR-CM were included (79% wild-type ATTR). Median age [IQR] was 81 [75-85] years and 21% were frail or very frail (SEGA score >8). Median follow-up was 2.3 years [1.7-3.1]. Frail patients had higher mortality than robust patients (36% vs 24%, p = 0.01). In multivariable analysis, frailty remained independently associated with mortality (HR 1.85, 95% CI 1.13-3.01). The inclusion of frailty improved model discrimination. Among SEGA domains, older age, need for assistance at home, and impaired functional and motor independence were significantly associated with mortality. CONCLUSIONS: Frailty assessed using the SEGA independently predicts mortality in ATTR-CM patients treated with tafamidis and improves prognostic stratification. It may also help identify potentially modifiable vulnerabilities warranting personalized multidisciplinary care.