**6. Natural history and prognosis**

The overall prognosis of cardiac amyloidosis depends on the type of amyloidogenic protein accumulating in the heart. For instance, AL-CM has the worst prognosis and is considered a hematologic emergency. It has a median survival of 6 months without disease-specific treatment. Therefore, it is imperative to differentiate between AL and ATTR-CM. On the other hand, ATTR is frequently misdiagnosed, leading to delayed diagnosis and treatment. Disease causes significant impairment in physical health, productivity, and lower quality of life. Once ATTR is diagnosed, untreated patients have a median survival of 2–3.5 years. There are multiple staging systems based on clinical as NYHA class, and laboratories such as NT-pro-BNP, troponin, and renal parameters which help delineate treatment strategist (**Table 2**).
