**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Karan Shahi, Libin Cardiovascular Institute (University of Calgary), Calgary Alberta (Canada)

**Main Body of the Abstract**
Background:
Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is an infiltrative process with poor prognosis when left untreated. While Health Canada defines clinical eligibility criteria for initiating therapy, some patients, despite meeting these criteria, may derive limited or no benefit from treatment. This study aimed to identify parameters that can be used to assess the clinical decision-making process for initiating or withholding therapy in ATTR-CM patients.
Methods:
Baseline parameters associated with ATTR-CM disease burden were collected, and logistic regression was employed to evaluate how these factors influenced the likelihood of treatment initiation.
Results:
A total of 145 patients with ATTR-CM were identified from 2011 to 2021. Patients initiated on therapy were younger at diagnosis [77.1 years (69.6-83.2 years) (n=86)] compared to those not on therapy [86.3 years (79.1-88.8 years) (n=59)] (p<0.05). Frail (clinical frailty scale score >4) patients demonstrated a 78% reduction in the likelihood of treatment initiation (p<0.05). Additionally, treated patients had lower baseline NTproBNP [2863.0 ng/L (1094.0-4061.0 ng/L) (n=59)] and Troponin T [54.5 ng/L (35.0-74.0 ng/L) (n=50)] values compared to untreated patients [6179.5 ng/L (2913.0-10872.0 ng/L) and 86.0 ng/L (56.0-132.0 ng/L), respectively] (both p<0.05). Those with a baseline NYHA functional class of ≥III were 67% less likely to undergo therapy initiation. Treated patients also exhibited significantly fewer comorbidities compared to the untreated group.
Conclusion:
Patients with frailty or more advanced ATTR-CM disease status at baseline were less likely to be initiated on therapy, potentially indicating a reduced likelihood of benefiting from treatment due to the progressive nature of this disease.



Determinants guiding clinical decision-making for treatment initiation in transthyretin amyloidosis cardiomyopathy patients in Canada PC115 (#219)

We invite you to attend the XIX International Symposium on Amyloidosis to be held in Rochester, MN.

This symposium is organized as a hybrid meeting (with the focus on in-person) held from Sunday, May 26 through Thursday, May 30, 2024.

Together with the ISA Board and members of Mayo Clinic, a very attractive scientific hybrid program is being planned. The program will cover a variety of types of systemic amyloidosis: ATTR (hereditary and wild-type), AL (light-chain), AA and less frequent forms. There will be key lectures, specific symposia including those company sponsored, oral presentations and poster sessions of accepted abstracts.

COURSE DESCRIPTION
This program will provide a comprehensive review of state-of-the-art education in systemic amyloidosis: basic science, pathophysiology, diagnosis, current and emerging treatments. Scientific presentations will include competitive oral and poster abstracts. The rapid evolution of scientific discovery and expanding treatment options has created tremendous interest in the field and this meeting will fill and important gap in educating scientists and clinicians.