What should be the treatment goals now that patients are diagnosed earlier than 5 years ago?

Abstract Cardiac amyloidosis (CA), particularly transthyretin amyloid cardiomyopathy (ATTR-CM), has undergone a profound transformation in its diagnostic and therapeutic landscape over the past decade. Advances in multimodality imaging, biomarker profiling, and non-invasive scintigraphy have enabled earlier and more accurate diagnosis, shifting the clinical profile of newly diagnosed patients toward less advanced disease stages. Historically, management was largely supportive, focused on symptom relief and management of heart failure complications, with limited impact on disease progression or survival. The introduction of disease-modifying therapies—most notably tafamidis, more recently acoramidis, and gene-silencing agents such as vutrisiran—has fundamentally altered treatment goals. Contemporary management now prioritises disease stabilisation, preservation of myocardial structure and function, and maintenance of patients in early New York Heart Association (NYHA) functional classes. Patients diagnosed and treated today generally exhibit slower disease progression, reduced rates of heart failure hospitalisation, and improved survival compared with cohorts treated approximately five years ago. Earlier therapeutic intervention is associated with better preservation of cardiac function, improved quality of life, and fewer arrhythmic and conduction complications. This review discusses the evolution of treatment goals in ATTR-CM, contrasting historical and contemporary management strategies, summarising outcomes associated with earlier versus later treatment, and addressing the clinical and ethical considerations surrounding early initiation of costly disease-modifying therapies.