%0 Journal Article
%T Conventional heart failure therapy in cardiac ATTR amyloidosis.
%A Ioannou A
%A Massa P
%A Patel RK
%A Razvi Y
%A Porcari A
%A Rauf MU
%A Jiang A
%A Cabras G
%A Filisetti S
%A Bolhuis RE
%A Bandera F
%A Venneri L
%A Martinez-Naharro A
%A Law S
%A Kotecha T
%A Virsinskaite R
%A Knight DS
%A Emdin M
%A Petrie A
%A Lachmann H
%A Wechelakar A
%A Petrie M
%A Hughes A
%A Freemantle N
%A Hawkins PN
%A Whelan C
%A McMurray JJV
%A Gillmore JD
%A Fontana M
%J Eur Heart J
%V 44
%N 31
%D 2023 08 14
%M 37216684
%F 35.855
%R 10.1093/eurheartj/ehad347
%X 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).<BR>A retrospective analysis of all consecutive patients diagnosed with ATTR-CA at the National Amyloidosis Centre between 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.<BR>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.