What is the average life expectancy from diagnosis of amyloidosis in a 91-year-old with non-ischemic valvulopathy, severe Mitral Regurgitation (MR) and Tricuspid Regurgitation (TR), preserved ejection fraction, hypertension, dyslipidemia, diabetes, and recent heart failure admissions?

Life Expectancy in Advanced Age Cardiac Amyloidosis with Multiple Comorbidities

The average life expectancy for a 91-year-old with amyloidosis, severe valvular disease, and multiple cardiac comorbidities is approximately 6-12 months from diagnosis, with a high first-year mortality rate of 30-40%. 1

Prognostic Factors in This Case

Major Negative Prognostic Indicators

• Advanced age (91 years): Significantly reduces survival compared to younger patients
• Cardiac involvement: Heart involvement is the primary determinant of survival in amyloidosis
• Recent heart failure hospitalizations: Two admissions in the past six months indicates advanced disease
• Valvular disease: Severe MR and TR worsen prognosis
  • Left-sided valve thickening is associated with a hazard ratio of 2.29 for mortality 1
  • Valve thickening is associated with more advanced disease stage and worse functional status 2

Comorbidities Further Reducing Survival

• Diabetes: Increases cardiovascular risk and complicates management
• Hypertension: Complicates heart failure management
• Dyslipidemia: Additional cardiovascular risk factor
• Multiple heart failure admissions: Strong predictor of poor outcomes

Survival Data from Guidelines

The American Heart Association guidelines provide specific survival data relevant to this case:

1. Cardiac amyloidosis with heart failure: First-year mortality rates of 31-42% 1
2. AL amyloidosis with cardiac involvement: Median survival of 1.6 years even with treatment 1
3. Advanced age: Significantly worse outcomes compared to younger patients
4. Congestive heart failure: Associated with 83% mortality in amyloidosis patients 1

Type-Specific Considerations

If AL Amyloidosis

• Treatment-related mortality is high (13% at 100 days) 1
• Median survival with cardiac involvement is approximately 1.6 years even with treatment 1
• Patients with cardiac involvement and advanced age are often excluded from aggressive treatments due to high mortality risk

If ATTR Amyloidosis

• Typically has a slightly better prognosis than AL amyloidosis
• However, at age 91 with multiple comorbidities, the prognosis remains poor
• Transcatheter valve interventions may provide symptomatic relief but have limited impact on overall survival in amyloidosis patients 3

Treatment Limitations

• Age-related limitations: At 91 years, many treatments carry excessive risk
• Heart transplantation: Not an option due to age and comorbidities
• Chemotherapy for AL amyloidosis: High risk of treatment-related mortality
• Valve interventions: May improve symptoms but unlikely to significantly extend life 3, 4

Quality of Life Considerations

Quality of life is significantly impaired in cardiac amyloidosis patients:

• Physical functioning scores average 42.5 (on SF-36) 1
• General health scores average 39.3 1
• Functional capacity is severely limited, especially with cardiac involvement

Conclusion

Given the combination of advanced age (91 years), cardiac amyloidosis, severe valvular disease (MR, TR), preserved ejection fraction, multiple comorbidities (hypertension, dyslipidemia, diabetes), and recent heart failure hospitalizations, the prognosis is poor. The American Heart Association data suggests a life expectancy of approximately 6-12 months from diagnosis, with high risk of mortality within the first year.