In part two of a discussion of data presented at ESC Heart Failure 2026, Apoorva Gangavelli, MD (Emory School of Medicine, CardioNerds Academy House Chief) and Daniel Judge, MD (Medical University of South Carolina), examine the prognostic impact of outpatient worsening heart failure in transthyretin amyloid cardiomyopathy (ATTR-CM) from the ATTRibute-CM trial. Nearly half of patients experienced diuretic intensification, which was strongly associated with increased mortality and cardiovascular hospitalization despite modest baseline differences. The conversation highlights how outpatient worsening may represent a key inflection point in disease trajectory and explores how acoramidis reduced these events while stabilizing disease progression—reinforcing the importance of early therapy and close monitoring of seemingly subtle clinical changes.
