{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T05:05:12Z","timestamp":1776229512664,"version":"3.50.1"},"reference-count":70,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Advanced chronic diseases, or multicomplexity in older adults presents unique challenges. Transthyretin cardiac amyloidosis (ATTR\u2010CA) is one such scenario where heart failure is a common presentation, and management remains challenging. We describe the challenges involved in the diagnosis of ATTR\u2010CA in older adults, which has implications on treatment options. We discuss the application of comprehensive geriatric assessment (CGA) and shared decision making (SDM) in the context of these challenges. Based on geriatric medicine principles, an innovative framework for applying SDM in ATTR\u2010CA patients is proposed, including consideration of the patient priorities care approach. The proposed framework emphasizes assessing functionality, frailty, and life expectancy to help categorize risk. This framework can be applied in various advanced chronic diseases or multicomplexity. Based on risk categorization, treatment burden, and alignment with values and preferences, management pathways are suggested for each risk category. Incorporating CGA and SDM, the proposed framework supports patient\u2010centered care, ensuring that clinical recommendations are tailored to each older adult's unique needs and goals. In ATTR\u2010CA, a collaboration between cardiology and geriatric medicine provides significant value in managing older adults. The need to prevent age\u2010related bias in clinical decision\u2010making exists across all health conditions, and the proposed framework allows for a thorough evaluation of multimorbidity, frailty, disability, and patient preferences. While ATTR\u2010CA is used as a prototype, this integrated approach can be applied across all health conditions and is essential for delivering holistic care, improving communication, and aligning treatment plans with patient values.<\/jats:p>","DOI":"10.1111\/jgs.70299","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T10:59:06Z","timestamp":1768561146000},"page":"954-963","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Pragmatic Framework for Shared Decision Making in Older Adults: Cardiac Amyloidosis as a Prototype"],"prefix":"10.1111","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6414-7974","authenticated-orcid":false,"given":"Monika","family":"Do","sequence":"first","affiliation":[{"name":"US Department of Veteran's Affairs  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandesh","family":"Dev","sequence":"additional","affiliation":[{"name":"Arizona State University  Phoenix Arizona USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pranav","family":"Pillai","sequence":"additional","affiliation":[{"name":"The University of Arizona College of Medicine \u2010 Phoenix and Banner University Medical Center  Phoenix Arizona USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ambar","family":"Andrade","sequence":"additional","affiliation":[{"name":"The University of Arizona College of Medicine \u2010 Phoenix and Banner University Medical Center  Phoenix Arizona USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Schmeckpeper","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan","family":"Branda","sequence":"additional","affiliation":[{"name":"Mayo Clinic  Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lori","family":"Herges","sequence":"additional","affiliation":[{"name":"Mayo Clinic  Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0838-1026","authenticated-orcid":false,"given":"Sandeep","family":"Pagali","sequence":"additional","affiliation":[{"name":"Mayo Clinic  Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9363-4461","authenticated-orcid":false,"given":"Nimit","family":"Agarwal","sequence":"additional","affiliation":[{"name":"The University of Arizona College of Medicine \u2010 Phoenix and Banner University Medical Center  Phoenix Arizona USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2019.12.034"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.11.022"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.118.005407"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10741\u2010021\u201010080\u20102"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.038169"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.024438"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2013.11.004"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/HCI.0000000000000029"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000792"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2021.04.006"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.3109\/10428199709059685"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19980415)82:8<1501::AID-CNCR11>3.0.CO;2-8"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2014.02.030"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.186093"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjco.2020.11.017"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/HCO.0000000000000841"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.026308"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/hsw\/36.4.249"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11886\u2010024\u201002172\u2010w"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.0863"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.045093"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.1738"},{"key":"e_1_2_12_24_1","unstructured":"\u201cMedication Cost \u201daccessed November 10 2025 https:\/\/www.fiercepharma.com\/pharma\/icer\u2010raises\u2010cost\u2010effective\u2010price\u2010pfizers\u2010attr\u2010drug\u2010final\u2010analysis\u2010still\u2010calls\u2010hefty\u2010discount."},{"key":"e_1_2_12_25_1","unstructured":"\u201cCardiac Amyloidosis Drug Cost \u201daccessed November 10 2025 https:\/\/www.managedhealthcareexecutive.com\/view\/fda\u2010approves\u2010attruby\u2010for\u2010hearth\u2010failure\u2010indication."},{"key":"e_1_2_12_26_1","unstructured":"\u201cFDA Approval Acoramidis \u201daccessed August 5 2025 https:\/\/www.fda.gov\/drugs\/news\u2010events\u2010human\u2010drugs\/fda\u2010approves\u2010drug\u2010heart\u2010disorder\u2010caused\u2010transthyretin\u2010mediated\u2010amyloidosis."},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2409134"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2023.4147"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1805689"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735\u20101097(23)00781\u20107"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532\u20105415.1991.tb05927.x"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2024.101123"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.5770\/cgj.23.463"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010009\u20101073\u2010y"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1177\/082585979601200102"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.20472"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15809"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.4235"},{"key":"e_1_2_12_39_1","unstructured":"\u201cMy Health Priorities \u201dhttps:\/\/myhealthpriorities.org\/."},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012\u2010016\u20100480\u20109"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1109283"},{"key":"e_1_2_12_42_1","volume-title":"Engaging Patients in Health Care","author":"Coulter A.","year":"2011"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003267.pub2"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003267"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749\u20106632.1978.tb22070.x"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10153415"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12247507"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.120.008105"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/ggi.14268"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcpt.13536"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2014.03.006"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2021.04.012"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16919"},{"key":"e_1_2_12_54_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001162"},{"key":"e_1_2_12_55_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.113.000322"},{"key":"e_1_2_12_56_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.004498"},{"key":"e_1_2_12_57_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X09353792"},{"key":"e_1_2_12_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2019.07.020"},{"key":"e_1_2_12_59_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11886\u2010016\u20100729\u20106"},{"key":"e_1_2_12_60_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.6617"},{"key":"e_1_2_12_61_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.121.007958"},{"key":"e_1_2_12_62_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.3779"},{"key":"e_1_2_12_63_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.120.007256"},{"key":"e_1_2_12_64_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136\u2010021\u201002943\u2010w"},{"key":"e_1_2_12_65_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325\u2010015\u20100250\u20100"},{"key":"e_1_2_12_66_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13023\u2010021\u201001706\u20107"},{"key":"e_1_2_12_67_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2014.03.043"},{"key":"e_1_2_12_68_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202002\u20100251ST"},{"key":"e_1_2_12_69_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15465"},{"key":"e_1_2_12_70_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2024.100981"},{"key":"e_1_2_12_71_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X211058068"}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.70299","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jgs.70299","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.70299","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T04:22:28Z","timestamp":1776226948000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.70299"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,16]]},"references-count":70,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1111\/jgs.70299"],"URL":"https:\/\/doi.org\/10.1111\/jgs.70299","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,16]]},"assertion":[{"value":"2025-07-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}