Temporal outcomes of patients diagnosed with transthyretin cardiac amyloidosis

BACKGROUND

Transthyretin cardiac amyloidosis (ATTR-CA) is increasingly recognized. Clinical outcomes have evolved over time amidst changes in the diagnostic pathway and advances in therapeutics.

OBJECTIVE

To evaluate clinical outcomes over time of ATTR-CA patients with access to disease-modifying therapy.

METHODS

This is a retrospective cohort study of 419 patients diagnosed with ATTR-CA during 2001-2021, comparing clinical characteristics across eras. The primary endpoint was composite all-cause mortality or orthotopic heart transplant (OHT). Time-to-event analysis was performed using Cox proportional hazard modeling controlling for differences amongst cohorts.

RESULTS

Patients diagnosed in the more recent years had higher median age (2017-2021: 78 years, 2014-2016: 75 years, 2001-2013: 74 years) and more often had ATTRwt (81.9% vs 82.5% vs. 56.4%) but less severe phenotypes as evidenced by more individuals with Columbia stage I disease (47.6% vs 35.9% vs 22.4%), due to lower biomarkers, more NYHA Class I-II patients (68.9% vs 47.6% vs. 43.6%), and lower use of loop diuretics (67.0% vs 78.6% vs 89.1%). Over time, patients were more frequently treated with Tafamidis (74% vs 37% vs 32%). On multivariable analysis, greater Columbia score (HR 1.42, 95% CI 1.30-1.54, p<0.001) was predictive of death or OHT, while Tafamidis (HR 0.31, 95% CI 0.22-0.44, p<0.001) was associated with greater survival and freedom from OHT.

CONCLUSIONS

Recently diagnosed ATTR-CA patients have earlier stage disease and substantially lower mortality. Tafamidis is associated with significantly improved survival and freedom from OHT.

Markers of nutritional status and inflammation in transthyretin cardiac amyloidosis: association with outcomes and the clinical phenotype

Background: Patients with transthyretin (TTR) cardiac amyloidosis demonstrate cardiac cachexia with progression of their cardiomyopathy, which is characterised by malnutrition and a heightened inflammatory state. How best to measure this condition is less well characterised. We investigated differences in survival among patients with ATTR cardiac amyloidosis by nutritional status as defined by modified BMI (mBMI) and by inflammatory state as defined by serum uric acid.Methods and results: This study was a retrospective analysis of patients diagnosed with ATTR cardiac amyloidosis at a single tertiary medical centre. Baseline characteristics were compared by nutritional status as measured by mBMI and by inflammatory state as measured by serum uric acid. Kaplan-Meier survival analyses were used to compare nutritional status and inflammatory status for the composite outcome of death. Cox proportional hazards modelling was used to assess predictors of death in this cohort. Three hundred patients (mean age 75 ± 11) years, 84.3% male) were included. Those with low mBMI (<1185 kg/m² g/L) had shorter time to death (5.4 vs. 6.8 years, log rank p = .045) and those with elevated serum uric acid (>8.8 mg/dL) had shorter time to death (4.9 vs. 7.7 years, log rank p < .0001). Those with both low mBMI and elevated serum uric acid had the shortest time to death (4.3 years, log rank p = .005). In this cohort, mBMI was not a univariate predictor of death though there was a trend towards significance (HR 0.92, per 100 kg/m² g/L, 95% CI 0.828-1.016, p = .099). Serum uric acid was a univariate predictor of death (HR 1.27 per 1 mg/dL, 95% CI 1.114-1.455, p < .001). In multivariate Cox analysis, this association remained significant (HR 1.31 per 1 mg/dL increase, 95% CI 1.096-1.560, p = .003) as well as in a separate stepwise model controlling for potential confounders including daily diuretic use, uric acid lowering therapy, and renal dysfunction.Conclusions: Both nutritional status as measured by mBMI and inflammation as measured by serum uric acid are associated with survival in patients with TTR cardiac amyloidosis however only serum uric acid is an independent predictor of death.

Resilient Coping and Social Networks in Old Age

Introduction

Both resilient coping strategies and the structural/functional characteristics of personal social networks are considered important factors when facing adversity and the challenges inherent to the aging process.

Objectives

To analyze the association between the configurations of ego-centred networks and different levels of resilient coping in a sample of elderly people.

Methods

Quantitative, cross-sectional study comparing groups, with 512 participants, mostly women (n = 325; 63.5%), married (n = 264; 51.5%), with 76 years old in average (SD ± 7.6), and with basic education (n = 261; 51%). We used a socio-demographic questionnaire, the IARSP-Elderly (personal social network assessment tool) and the Brief Resilient Coping Scale for data collection.

Results

We found different levels of resilient coping in our sample: low (50.4%); medium (38,7%); strong (10.9%). These three levels of coping were associated with the composition of ego-centred networks, namely the proportion of friends and colleagues (P < 0.05), different perceived emotional support, reciprocity and satisfaction with the network (P < 0.05), frequency of contacts and relationships’ durability (P < 0.05).

Conclusions

Higher levels of coping are associated with a larger proportion of friends in the network, whereas the familistic networks are associated with low coping. Although participants in our study revealed mainly kin comprised networks, these results reflect the relevance of resilient coping in the activation of non-kin relationships in old age.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Time spent in retirement, health and well-being

Introduction

From a life-span developmental perspective, retirement can be considered a life event that entails a complex psychological challenge, including leaving one's professional life and organizing/enjoying the newly available free time. The literature about retirement identifies different stages and patterns of transition/adaption associated with time spent in retirement.

Objectives

To analyze the association between time spent in retirement and subjective measures of mental health, depressive symptomatology, loneliness and satisfaction with life.

Methods

Quantitative cross-sectional study with 641 participants (M = 74,86). The instruments included: sociodemographic questionnaire; mental health inventory (MHI-5); geriatric depression scale (GDS); UCLA loneliness scale; satisfaction with life scale (SWLS).

Results

Statistically significant differences in all the health and well-being variables addressed were found between subgroups of time spent in retirement (MHI-5: P = 0.001; GDS: P < 0.001; UCLA: P = 0.038; SWLS: P = 0.022). Mental health and satisfaction with life increases in the first year after retirement, but during the second year, they decrease to the levels found in pre-retirement. Loneliness and depressive symptomatology follow an inverted pattern. With the passing of years, loneliness and depression tend to increase; mental health and satisfaction with life tend to decrease.

Conclusions

The results provide support to the hypotheses of honeymoon and disenchantment phases in the recently retired and to the existence of different patterns of transition/adaptation associated with time spent in retirement. They also highlight the relevance of devising intervention strategies that enable individuals to maintain the satisfaction levels with life and mental health achieved during the first phase of retirement.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The temporal evolution of life satisfaction in institutionalized elderly: A longitudinal study

Introduction

Research shows that variables, such as depression, less functionality and health, less contact with family and others, may have a negative impact on life satisfaction.

Objectives

To verify which variables correlate with satisfaction with life (SWL) and analyse which of them predict the evolution of SWL.

Aims

To examine correlates and predictors of SWL in institutionalized elderly.

Methods

This study involved a subsidiary longitudinal analysis of cross-sectional data gathered at Phase I (2010–2012; n = 493 elderly) and after 36 months at Phase II (2013–2014; n = 85) of Aging Trajectories Project from Miguel Torga University College.

Results

At Phase I, higher scores in SWL scale correlated with having visits (r = 0.17; P < 0.01), specially from family (r = 0.20; P < 0.01), less depressive (r = –0.42; P < 0.001) and anxiety symptoms (r = –0.25; P < 0.001), less loneliness feelings (r = –0.37; P < 0.001), less functionality (r = 0.15; P < 0.01), and better general physical health (r = 0.25; P < 0.001). Age, sex, civil status, cognitive, and executive status did not correlate with SWL. SWL, depressive and anxiety symptoms, and loneliness feelings were stable through time, between assessment stages (P < 0.01). The worsening of depression and loneliness through time predicted the negative evolution of SWL (respectively, β = 1.16; P < 0.01; β = –0.69; P < 0.05).

Conclusions

These findings highlight the relevance of early detecting depressed mood and loneliness feelings in institutionalized elderly, and the importance of the treatment and the development of preventive interventions for this vulnerable population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.