A Return to Munich: Reflecting on Eight Years of Progress in ATTR-CM

Eight years ago, few people had heard of transthyretin amyloid cardiomyopathy (ATTR-CM), and it was rarely diagnosed in cardiology practice.^1,2 Today, it is a treatable condition that cardiologists and heart failure specialists actively screen for, with dedicated clinics, imaging pathways, and a growing evidence base.

ATTR-CM is a rare and underdiagnosed cause of heart failure characterized by the abnormal buildup of misfolded transthyretin (TTR) protein depositing in the heart.¹ For years, it was hiding in plain sight, often mistaken for more common causes of heart failure.

This August, the European Society of Cardiology (ESC) Congress returns to Munich, Germany, the same city where, eight years ago, Pfizer’s pivotal ATTR-ACT trial readout introduced many in the cardiology community to ATTR-CM, sparking a new chapter in the field.

ATTR-CM is a serious and often underrecognized disease. The progress in ATTR-CM management over the past eight years reflects the commitment and collaboration of the broader cardiology community,” said Francesca Biondo, Global Head Medical Rare Cardiology, Pfizer. “We're proud to have contributed to that progress, and we remain focused on the work that lies ahead.

Eight Years of Evidence, Built by the ATTR-CM Community

Compared with historic, pre-treatment-era populations of patients with ATTR-CM, in the past eight years we have seen substantially lower mortality rates, reduced hospitalizations, and better preservation of quality of life and functional capacity.^3,4 These improvements in outcomes for people living with ATTR-CM have been a direct result of sustained work across the cardiology community. This includes researchers, clinical trial sites, patient organizations, and patients themselves who took part in studies often spanning years of follow-up.

Pfizer has contributed to this effort since the first ATTR-CM treatment was approved in 2019. The ATTR-ACT readout at ESC in Munich in 2018 was the first Phase 3, double-blind, placebo-controlled trial in ATTR-CM and it helped open a new era of research into the disease.

Since then, our focus has stayed consistent: improving earlier diagnosis, following patients over the long term, and generating real-world evidence.

Why Are More Patients Being Diagnosed With ATTR-CM?

One of the most notable developments has been the growing number of people diagnosed with ATTR-CM.³ This rise reflects a growing awareness and recognition of the disease and its early indicators among cardiologists.³ It also reflects the introduction of non-invasive techniques that have helped identify ATTR-CM sooner, including cardiac imaging, bone scintigraphy, and the clinical evaluation of red-flag symptoms, as well as improved referral pathways.⁵ As a result, more patients are being identified and treated at an earlier stage of the disease, leading to improved survival.^5,6

Where do our Biggest Opportunities to Improve Patient Outcomes in ATTR-CM Remain?

As awareness grows, diagnostics advance, and more approved treatment options become available, more people living with ATTR-CM are gaining access to care and support. Despite this progress, ATTR-CM remains under- and misdiagnosed, and its true prevalence is still not fully understood.⁷ Nearly half of patients are initially diagnosed with another heart condition before ATTR-CM is identified.⁸ On average, patients with ATTR-CM are diagnosed more than 3 years after symptoms first appear.⁷ Awareness of the disease among cardiologists also varies between regions and subspecialties, with many patients reporting seeing more than five doctors before ATTR-CM is identified.⁷

Within ATTR-CM diagnosis, there is also a significant gender disparity, with women historically underdiagnosed. This is partly due to a focus on older male patients in whom it is most common and exacerbated by the fact that women can present differently.⁹

Due to its progressive nature, early diagnosis and treatment initiation remains the biggest opportunity to improve patient outcomes and extend survival for people living with ATTR-CM. Catching it sooner can help them reach specialist care more quickly, support better long-term management and ultimately improve outcomes.

Pfizer’s Commitment to Advancing ATTR-CM Science

Eight years on, the ATTR-CM landscape has evolved. Earlier diagnoses are more common, clinician awareness has grown, clinical evidence continues to expand, and guide care. Despite this, too many patients are still waiting too long for a diagnosis. That gap is where the next phase of work needs to focus.

Pfizer remains committed to making a difference for the ATTR-CM community through ongoing research, partnerships, and engagement with patient communities whose experiences shape the science.

What Will Pfizer Present at ESC 2026?

At ESC 2026, Pfizer is presenting new analyses from the ATTR-ACT program and from real-world practice, including:

A post hoc analysis examining the relationship between quality of life and survival
An analysis of how transthyretin stabilization relates to patients' functional capacity
An analysis of kidney function over time
Real-world data on how ATTR-CM presents differently in women and men

This research is helping clinicians and patients understand what to expect and how to support diagnosis and management of ATTR-CM in the years ahead.

Eight years ago, Munich marked the start of a new chapter for ATTR-CM as a treatable disease. This year, the same city hosts a field that diagnoses the disease earlier with improved diagnostic tools and a unified purpose to close the gap between first symptom and diagnosis for the patients still waiting on the other side of that timeline.

Learn more about ATTR-CM:

Download our infographic for more information on ATTR-CM, or learn more at PfizerForAll
Read more about Pfizer's work to improve recognition of ATTR-CM: Spotting the Signs of ATTR-CM

References
1. Ruberg FL, Berk JL. Transthyretin (TTR) cardiac amyloidosis. Circulation. Sep 4 2012;126(10):1286–300. doi:10.1161/CIRCULATIONAHA.111.078915
2. Achten A, van Empel VPM, Weerts J, et al. Changes in the diagnostic trajectory of transthyretin cardiac amyloidosis over six years. Heart Vessels. 2024;39(10):857-866. doi:10.1007/s00380-024-02408-3
3. Fontana M, Berk JL, Drachman B, et al. Changing Treatment Landscape in Transthyretin Cardiac Amyloidosis. Circ Heart Fail. Aug 2025;18(8):e012112. doi:10.1161/CIRCHEARTFAILURE.124.012112
4. Ioannou A, Patel RK, Razvi Y, et al. Impact of Earlier Diagnosis in Cardiac ATTR Amyloidosis Over the Course of 20 Years. Circulation. Nov 29 2022;146(22):1657–1670. doi:10.1161/CIRCULATIONAHA.122.060852
5. Kittleson MM, Ambardekar AV, Cheng RK, et al. Transthyretin Cardiac Amyloidosis Evaluation and Management: 2025 ACC Concise Clinical Guidance. JACC. 2026;87(5):549–565. doi:doi:10.1016/j.jacc.2025.09.004
6. Garcia-Pavia P, Witteles RM, Damy T, et al. Monitoring Disease Progression in Patients With Transthyretin Amyloid Cardiomyopathy. JACC Heart Fail. Jan 2026;14(1):102766. doi:10.1016/j.jchf.2025.102766
7. Rozenbaum MH, Large S, Bhambri R, et al. Impact of Delayed Diagnosis and Misdiagnosis for Patients with Transthyretin Amyloid Cardiomyopathy (ATTR-CM): A Targeted Literature Review. Cardiol Ther. Jun 2021;10(1):141–159. doi:10.1007/s40119-021-00219-5
8. Willet A. CH, Inês M., et al. ACC 75th Annual Scientific Sessions – Describing the Diagnostic Journeys of Transthyretin Amyloid Cardiomyopathy Patients in the United States: A Real-World Survey. . 2026:
9. Ciocca N, Fuentes Artiles R, Studer Bruengger A, et al. Sex Differences in Presentation and Outcomes of Transthyretin Amyloid Cardiomyopathy. JACC Adv. Jul 28 2026;5(8):103068. doi:10.1016/j.jacadv.2026.103068