{Reference Type}: Journal Article
{Title}: Conventional heart failure therapy in cardiac ATTR amyloidosis.
{Author}: Ioannou A;Massa P;Patel RK;Razvi Y;Porcari A;Rauf MU;Jiang A;Cabras G;Filisetti S;Bolhuis RE;Bandera F;Venneri L;Martinez-Naharro A;Law S;Kotecha T;Virsinskaite R;Knight DS;Emdin M;Petrie A;Lachmann H;Wechelakar A;Petrie M;Hughes A;Freemantle N;Hawkins PN;Whelan C;McMurray JJV;Gillmore JD;Fontana M;
{Journal}: Eur Heart J
{Volume}: 44
{Issue}: 31
{Year}: 2023 08 14
{Factor}: 35.855
{DOI}: 10.1093/eurheartj/ehad347
{Abstract}: 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.