DemonsTTRate: A Global, Observational, Multicenter, Long-term Study of Patients With ATTR-CM in a Real-World Setting

Primary outcomes

1. New York Heart Association (NYHA) Class

   Time frame: From time of ATTR-CM diagnosis up to 5 years

   The NYHA functional classification categorizes the severity of heart failure. Patients are classified in 1 of 4 categories based on their physical limitations, as follows:

   • Class I No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or shortness of breath.
   • Class II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, shortness of breath or chest pain.
   • Class III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, shortness of breath or chest pain.
   • Class IV Symptoms of heart failure at rest. Any physical activity causes further discomfort.

2. Outpatient Diuretic Intensification

   Time frame: From time of enrollment for up to 5 years

   The clinician-reported outcome of ODI, which measures any post-diagnosis initiation or increase in the dose of loop diuretics, may help identify patients with ATTR-CM who are at an increased risk for adverse outcomes. ODI, a marker to monitor disease progression and/or worsening heart failure, is associated with a higher risk of all-cause mortality, cardiovascular hospitalizations, and urgent heart failure visits. Clinicians monitor ODI to help manage patients with ATTR-CM.

3. Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Total Score

   Time frame: From time of enrollment (if available) or ATTR-CM diagnosis up to 5 years

   Norfolk-QoL-DN: The Norfolk QOL-DN questionnaire is a standardized 35-item patient-reported outcomes measure that assesses 6 domains: physical function, large-fiber neuropathy, activities of daily living, symptoms, small-fiber neuropathy, and autonomic neuropathy. The total score ranges from -4 points (best possible quality of life) to 136 points (worst possible quality of life).

4. Kansas City Cardiomyopathy Questionnaire (KCCQ)

   Time frame: From time of enrollment (if available) or ATTR-CM diagnosis up to 5 years

   The KCCQ is a 23-item self-administered questionnaire developed to independently measure the patient's perception of health status, which includes heart failure symptoms, impact on physical and social function, and how their heart failure impacts their quality of life within a 2-week recall period. The KCCQ quantifies 6 domains (symptoms, physical function, quality of life, social limitation, self-efficacy, and symptom stability) and 2 summary scores (clinical and overall summary [OS] scores).

5. Patient Global Impressions - Change (PGI-C)

   Time frame: From time of enrollment (if available) or ATTR-CM diagnosis up to 5 years

   The PGI-C is a 7-point numerical rating scale where 1 indicates "very much improved" and 7 indicates "very much worse."

6. Patient Global Impressions - Severity (PGI-S);

   Time frame: From time of enrollment (if available) or ATTR-CM diagnosis up to 5 years

   The PGI-S is a 7-point numerical rating scale where 1 indicates "very much improved" and 7 indicates "very much worse."

7. Treatment Satisfaction Questionnaire for Medication version 9 (TSQM-9)

   Time frame: From time of enrollment (if available) or ATTR-CM diagnosis up to 5 years

   TSQM-9 is a 9-item general instrument that measures the major dimensions of satisfaction with a medication. The questionnaire consists of 3 domains: effectiveness, convenience and side effects. The scores of each domain range from 0 to 100 with higher scores representing higher satisfaction on that domain.