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In patients with Transthyretin Amyloidosis Cardiomyopathy (ATTR-CM), tafamidis was associated with a lower rate of CV-related hospitalizations and a shorter stay.

Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is an underdiagnosed disease characterized by deposits of improperly folded transthyretin amyloid fibrils, resulting in end-organ dysfunction. ATTR-CM patients present with symptoms of invasive cardiomyopathy and heart failure necessitating expensive hospitalizations. Tafamidis’ effectiveness in reducing the number of cardiovascular (CV)-related hospitalizations has been reported in the literature.

This study, published in the American Journal of Cardiovascular Drugs, aimed to understand the effect of tafamidis on the number of CV-related hospital days avoided in the management of ATTR-CM patients, since the length of stay can affect the overall burden of hospitalization.

The total burden of CV-related hospitalization (days) by the treatment arm was determined using the retrospective data from the Transthyretin Amyloidosis Cardiomyopathy Clinical Trial (ATTR-ACT). Those patients who stayed in the hospital for a minimum of 24 hours with a diagnosis of CV-related problem were included.

Compared to the placebo, tafamidis dramatically reduced the annual rate of CV-related hospitalizations in the intent-to-treat population of ATTR-ACT by 32.4%. Patients on tafamidis had significantly fewer CV-related hospitalizations annually in the whole trial population (relative risk p < 0.0001) and shorter mean lengths of stay for each such event (8.6250 vs. 9.5625 days). Tafamidis prevented 2.62 CV-related hospitalization days per patient-year in the general population (4,0969 vs. 6,7177 days). The findings of the study demonstrate the superiority of tafamidis both in the whole population and baseline NYHA class I/II subpopulation, showing that it prevents more CV-related hospitalization episodes and inpatient days per year of therapy than placebo.

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Tafamidis collectively prevented 2.62 patient-years of hospitalization due to CV. According to subgroup analysis, the annual frequency of CV-related hospitalizations was significantly reduced by 52% with earlier treatment initiation with tafamidis compared to placebo (p <0.0001). Tafamidis decreased the annual number of CV-related hospitalization days by 3.96 days per New York Heart Association class I/II patient or 1.14 fewer days for each hospitalization. This study concluded that tafamidis was linked to a decreased rate of CV-related hospitalizations and a shorter length of stay in individuals with ATTR-CM. The overall number of days spent in hospitals owing to cardiovascular disease (CV) could be further reduced with prompt diagnosis and treatment with tafamidis. The study also projected that tafamidis could prevent over 27,500 CV-related hospitalization days in the United States annually. In the actual world, treating more patients with tafamidis may increase the number of needless CV-related inpatient days. Reference: Rozenbaum, M. H., Tran, D., Bhambri, R., & Nativi-Nicolau, J. (2022). Annual Cardiovascular-Related Hospitalization Days Avoided with Tafamidis in Patients with Transthyretin Amyloid Cardiomyopathy. American Journal of Cardiovascular Drugs, 22(4), 445-450. doi:10.1007/s40256-022-00526-9