Conference Coverage

Outpatient Worsening Heart Failure Predicts Outcomes in ATTR-CM

Edited by:
Ashton L. Stahl

Key Highlights

  • Among 236 patients with ATTR-CM, 29.3% experienced outpatient worsening heart failure.
  • Outpatient worsening heart failure predicted death or first heart failure hospitalization after adjustment for NAC stage.
  • It also predicted recurrent heart failure hospitalization, with an adjusted hazard ratio of 6.23.

Outpatient worsening heart failure (OWHF) was associated with higher risks of death or first heart failure (HF) hospitalization and recurrent HF hospitalization in patients with transthyretin amyloid cardiomyopathy (ATTR-CM), according to an abstract being presented at the American Heart Association Scientific Sessions 2026.

Researchers retrospectively analyzed 236 patients from the Columbia University Cardiac Amyloidosis Registry who underwent baseline and follow-up multimodal assessments on the same day. They evaluated 4 progression domains: a decline of at least 35 m in the 6-minute walk test distance, a decline of more than 5 points in the Kansas City Cardiomyopathy Questionnaire, NT-proBNP worsening exceeding both 700 pg/mL and a 30% increase, and OWHF. The researchers defined OWHF as new loop diuretic initiation or sustained dose escalation for at least 30 days.

The primary endpoint was a composite of all-cause mortality or first HF hospitalization, analyzed using Cox regression. Recurrent HF hospitalization was the secondary endpoint, evaluated using a Prentice-Williams-Peterson model. The authors analyzed each predictor individually and adjusted for the National Amyloidosis Centre (NAC) stage.

Study Findings

Patients had a median age of 78 years; 89% were male, and 82% had wild-type ATTR-CM. During observation, 29.3% experienced OWHF, comprising 10.2% with new loop diuretic initiation and 19.1% with sustained dose escalation. Median post-landmark follow-up was 17.8 months. Overall mortality and total HF hospitalization rates were 8.4 and 13.4 per 100 person-years, respectively. Patients with OWHF had mortality rates of 15.2 versus 4.8 and HF hospitalization rates of 32.7 versus 3.2 per 100 person-years compared with those without OWHF.

All 4 progression domains predicted the composite outcome after adjustment for the NAC stage. Adjusted hazard ratios were 2.41 for walking-distance decline (95% CI, 1.25–4.64), 2.60 for questionnaire-score decline (95% CI, 1.34–5.03), 2.89 for NT-proBNP worsening (95% CI, 1.48–5.63), and 3.46 for OWHF (95% CI, 1.78–6.74). OWHF also predicted recurrent HF hospitalization (adjusted hazard ratio, 6.23; 95% CI, 2.48–15.62; P < .001).

Clinical Implications

According to the study authors, OWHF’s objectivity, simplicity, and predictive value support incorporating it into disease progression monitoring and considering it as a clinical trial endpoint.

Expert Commentary

“OWHF is a robust independent predictor of composite all-cause mortality/HF hospitalization and recurrent HF hospitalization. Its objectivity, simplicity, and predictive value support integration into disease progression monitoring and consideration as a trial endpoint,” the researchers concluded.

Reference

Barrera N, Ansari B, Ravalli F, et al. Outpatient worsening heart failure: an emerging predictor of mortality and recurrent heart failure hospitalization alongside functional, quality of life and biomarker assessments in ATTR-CM. Abstract Su3022. Presented at: American Heart Association Scientific Sessions 2026; November 8, 2026.