The intersectionality of cardiac amyloidosis, aging and frailty is the focus of a State-of-the-Art Review published May 15 in JACC: Advances.

Authored by a team of experts in cardiology, geriatric cardiology, geriatrics, hematology and allied health, the review explores features of amyloidosis, including its classification as a multisystem disease, the overlap between amyloidosis and conditions like frailty and heart failure (HF), and multidisciplinary care recommendations for the management of patients with both cardiac amyloidosis and frailty.

Nicole K. Bart, MBBS, DPhil, et al., for the ACC Geriatric Cardiology Leadership Council highlight the multisystem impact of amyloidosis, including its cardiac, gastrointestinal, neurological and skeletal muscle involvement, and point out "red flags" for cardiac amyloidosis such as "aortic stenosis, cardiac disease plus orthopedic and neurologic manifestations such as carpel tunnel syndrome and lumbar canal stenosis."

In addition to physical frailty, the authors highlight malnutrition, cognitive impairment, mood disorders and social isolation as all factors contributing to the condition. When discussing the intersection of cardiac amyloidosis and frailty, they state that "chronic low-grade inflammation, or 'inflammaging,' is a hallmark of aging and is implicated in the pathogenesis of both conditions…The chronic inflammatory state often seen in frailty may exacerbate amyloid fibril formation and deposition, accelerating disease progression."

Bart and colleagues also lay out an approach for measuring frailty in cardiac amyloidosis and call out the role of nutrition, specialist nursing and allied health in management.

They recommend a comprehensive care plan for transthyretin amyloidosis and light chain amyloidosis patients with frailty, including social support, a structured physical exercise program featuring resistance training, and protein or caloric supplementation.

"Frailty is highly prevalent within the population of patients with amyloidosis, especially those that suffer from [transthyretin cardiac amyloidosis] (with or without HF symptoms)," write the authors. "Understanding the interplay between frailty, aging and amyloidosis, therefore, can help our understanding of the pathophysiology of disease, as well as early implementation of frailty assessments and interventions."