Mortality in octogenarian patients with transthyretin amyloidosis treated with tafamidis: a systematic review and meta-analysis

BACKGROUND: Transthyretin amyloid cardiomyopathy (ATTR-CM) predominantly affects older adults, and tafamidis has proven efficacy in reducing mortality and hospitalizations in this population. However, its clinical benefit in octogenarians remains uncertain due to limited life expectancy, frailty, and other age-related factors. This meta-analysis evaluates the effect of tafamidis in patients aged ≥ 80 years, aiming to address the gap in evidence regarding the therapy's impact in this population. METHODS: A systematic review and meta-analysis were conducted by searching PubMed, Embase, and Cochrane databases for studies comparing tafamidis versus control in patients aged ≥ 80 years with transthyretin amyloidosis. The primary outcome was all-cause mortality. Hazard ratios (HRs) were pooled using a random-effects model, and heterogeneity was assessed using I² statistics. RESULTS: Three studies with a total of 1,866 participants were included (1 randomized controlled trial, 1 prospective cohort, and 1 retrospective study). The majority (77.3%) of patients received tafamidis, and the mean age was 84 years. Tafamidis was associated with a significant reduction in all-cause mortality (HR: 0.51; 95% CI 0.40-0.67; p < 0.01; I² = 10.3%). Sensitivity analyses confirmed the robustness of this finding. The tafamidis group showed no increased risk of adverse events compared to controls. CONCLUSION: Tafamidis significantly reduces all-cause mortality in octogenarian patients with ATTR-CM, supporting its use as a cornerstone therapy in this population. Further randomized controlled trials are needed to validate these findings and optimize treatment strategies in very elderly patients with advanced disease or comorbidities.