Patient selection for tafamidis should reflect the inclusion criteria for the major randomized controlled clinical trial that showed clinical benefits of tafamidis over placebo with respect to mortality and cardiovascular hospitalization, including established ATTR-CA and objective evidence of HF (with elevated natriuretic peptides where available).<\/p>\n
Patients with New York Heart Association (NYHA) class IV symptoms or severe functional disability, measured using a 6-minute walk test < 100 m, were excluded from ATTR-ACT and should not routinely be considered for treatment with tafamidis.<\/p>\n
Subgroup analysis from the ATTR-ACT trial suggested that the reduction in cardiovascular hospitalizations seen with tafamidis might be limited to patients with less severe symptoms (NYHA class I or II).<\/p>\n
Because of the complexity in diagnosing CA and the potential for offering advanced or experimental treatment options, consideration should be given to referring patients with CA to experienced centres.<\/p>\n
Other agents are currently under investigation, which might modify current treatment recommendations.<\/p>\n<\/div>\n\n\n
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References<\/h2>
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17. Ledwidge M, Gallagher J, Conlon C, et al. Natriuretic peptide-based screening and collaborative care for heart failure: the STOP-HF randomized trial. JAMA 2013;310:66-74.<\/p>\n
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18. Huelsmann M, Neuhold S, Resl M, et al. PONTIAC (NT-proBNP selected prevention of cardiac events in a population of diabetic patients without a history of cardiac disease): a prospective randomized controlled trial. J Am Coll Cardiol 2013;62:1365-72.<\/p>\n
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19. Pandey A, Garg S, Khunger M, et al. Dose-response relationship between physical activity and risk of heart failure: a meta-analysis. Circulation 2015;132:1786-94.<\/p>\n
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20. Eriksson H, Svardsudd K, Larsson B, et al. Risk factors for heart failure in the general population: the study of men born in 1913. Eur Heart J 1989;10:647-56.<\/p>\n
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21. Ho KK, Pinsky JL, Kannel WB, Levy D. The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol 1993;22:6A-13A.<\/p>\n
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22. Nicklas BJ, Cesari M, Penninx BW, et al. Abdominal obesity is an independent risk factor for chronic heart failure in older people. J Am Geriatr Soc 2006;54:413-20.<\/p>\n
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23. Kenchaiah S, Gaziano JM, Vasan RS. Impact of obesity on the risk of heart failure and survival after the onset of heart failure. Med Clin North Am 2004;88:1273-94.<\/p>\n
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24. Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med 2002;347:305-13.<\/p>\n
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25. Aune D, Sen A, Norat T, et al. Body mass index, abdominal fatness, and heart failure incidence and mortality: a systematic review and doseresponse meta-analysis of prospective studies. Circulation 2016;133: 639-49.<\/p>\n
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26. Baena-Diez JM, Byram AO, Grau M, et al. Obesity is an independent risk factor for heart failure: Zona Franca Cohort study. Clin Cardiol 2010;33:760-4.<\/p>\n
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27. Fitchett D, Zinman B, Wanner C, et al. Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high cardiovascular risk: results of the EMPA-REG OUTCOME(R) trial. Eur Heart J 2016;37: 1526-34.<\/p>\n
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28. Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA 1996;275: 1557-62.<\/p>\n
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29. Bell DS. Heart failure: the frequent, forgotten, and often fatal complication of diabetes. Diabetes Care 2003;26:2433-41.<\/p>\n
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30. Turnbull F. Blood Pressure Lowering Treatment Trialists\u2019 Collaboration. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 2003;362:1527-35.<\/p>\n
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31. Williamson JD, Supiano MA, Applegate WB, et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged 75 years: a randomized clinical trial. JAMA 2016;315: 2673-82.<\/p>\n
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32. Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol 1974;34:29-34.<\/p>\n
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33. He J, Ogden LG, Bazzano LA, et al. Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med 2001;161:996-1002.<\/p>\n
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34. Sharma A, Ezekowitz JA. Diabetes, impaired fasting glucose, and heart failure: it\u2019s not all about the sugar. Eur J Heart Fail 2014;16:1153-6.<\/p>\n
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3. Treatment of CA: Focus on Transthyretin CA - Soci\u00e9t\u00e9 cardiovasculaire du Canada<\/title>\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\t \n