TTR and heart failure: Tafamidis, a TTR-stabilising agent, has received a class 1B recommendation in the European Society of Cardiology heart failure guidelines for use in ATTR-CM patients with NYHA class I or II symptoms.23 Clinical trials examining other TTR-stabilising agents, gene silencers and gene editing technologies are showing promise.24 25 This prospective study highlights the importance of maintaining a high-degree of suspicion for ATTR-CM in older patients requiring a PPM so that they too can be offered disease-modifying therapy.