Conventional heart failure therapy in cardiac ATTR amyloidosis

58Citations
Citations of this article
45Readers
Mendeley users who have this article in their library.

Abstract

Aims The aims of this study were to assess prescription patterns, dosages, discontinuation rates, and association with prognosis of conventional heart failure medications in patients with transthyretin cardiac amyloidosis (ATTR-CA). Methods A retrospective analysis of all consecutive patients diagnosed with ATTR-CA at the National Amyloidosis Centre between and results 2000 and 2022 identified 2371 patients with ATTR-CA. Prescription of heart failure medications was greater among patients with a more severe cardiac phenotype, comprising beta-blockers in 55.4%, angiotensin-converting enzyme inhibitors (ACEis)/ angiotensin II receptor blockers (ARBs) in 57.4%, and mineralocorticoid receptor antagonists (MRAs) in 39.0% of cases. During a median follow-up of 27.8 months (interquartile range 10.6–51.3), 21.7% had beta-blockers discontinued, and 32.9% had ACEi/ ARBs discontinued. In contrast, only 7.5% had MRAs discontinued. A propensity score-matched analysis demonstrated that treatment with MRAs was independently associated with a reduced risk of mortality in the overall population [hazard ratio (HR) 0.77 (95% confidence interval (CI) 0.66–0.89), P < .001] and in a pre-specified subgroup of patients with a left ventricular ejection fraction (LVEF) >40% [HR 0.75 (95% CI 0.63–0.90), P = .002]; and treatment with low-dose beta-blockers was independently associated with a reduced risk of mortality in a pre-specified subgroup of patients with a LVEF ≤40% [HR 0.61 (95% CI 0.45–0.83), P = .002]. No convincing differences were found for treatment with ACEi/ARBs. Conclusion Conventional heart failure medications are currently not widely prescribed in ATTR-CA, and those that received medication had more severe cardiac disease. Beta-blockers and ACEi/ARBs were often discontinued, but low-dose beta-blockers were associated with reduced risk of mortality in patients with a LVEF ≤40%. In contrast, MRAs were rarely discontinued and were associated with reduced risk of mortality in the overall population; but these findings require confirmation in prospective randomized controlled trials.

References Powered by Scopus

The effect of spironolactone on morbidity and mortality in patients with severe heart failure

8233Citations
N/AReaders
Get full text

2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

7973Citations
N/AReaders
Get full text

Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure

0
7014Citations
N/AReaders
Get full text

Cited by Powered by Scopus

SGLT2 Inhibitor Therapy in Patients With Transthyretin Amyloid Cardiomyopathy

41Citations
N/AReaders
Get full text

Cardiac Amyloidosis Due to Transthyretin Protein

31Citations
N/AReaders
Get full text

Stratifying Disease Progression in Patients With Cardiac ATTR Amyloidosis

23Citations
N/AReaders
Get full text

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Cite

CITATION STYLE

APA

Ioannou, A., Massa, P., Patel, R. K., Razvi, Y., Porcari, A., Rauf, M. U., … Fontana, M. (2023). Conventional heart failure therapy in cardiac ATTR amyloidosis. European Heart Journal, 44(31), 2893–2907. https://doi.org/10.1093/eurheartj/ehad347

Readers over time

‘23‘24‘2507142128

Readers' Seniority

Tooltip

PhD / Post grad / Masters / Doc 10

48%

Researcher 8

38%

Professor / Associate Prof. 3

14%

Readers' Discipline

Tooltip

Medicine and Dentistry 22

79%

Social Sciences 3

11%

Pharmacology, Toxicology and Pharmaceut... 2

7%

Sports and Recreations 1

4%

Article Metrics

Tooltip
Mentions
News Mentions: 1
References: 1
Social Media
Shares, Likes & Comments: 14

Save time finding and organizing research with Mendeley

Sign up for free
0