Conventional heart failure therapy in cardiac ATTR amyloidosis
Adam Ioannou1, Paolo Massa1, Rishi K Patel1
1National Amyloidosis Centre, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK.
European Heart Journal
|May 22, 2023
Summary
Mineralocorticoid receptor antagonists (MRAs) and low-dose beta-blockers show promise in treating transthyretin cardiac amyloidosis (ATTR-CA). MRAs reduced mortality in all patients, while beta-blockers benefited those with reduced ejection fraction.
Area of Science:
- Cardiology
- Pharmacology
- Genetics
Background:
- Transthyretin cardiac amyloidosis (ATTR-CA) is a progressive disease often associated with heart failure.
- Conventional heart failure medications are not routinely prescribed for ATTR-CA patients.
- Understanding the impact of these medications on ATTR-CA prognosis is crucial for patient management.
Purpose of the Study:
- To evaluate the prescription patterns, dosages, and discontinuation rates of standard heart failure drugs in ATTR-CA patients.
- To determine the association between these medications and patient prognosis in ATTR-CA.
Main Methods:
- Retrospective analysis of 2371 ATTR-CA patients diagnosed between 2000 and 2022.
- Assessment of heart failure medication use (beta-blockers, ACEis/ARBs, MRAs) and discontinuation rates.
- Propensity score-matched analysis to evaluate the association of medications with mortality risk.
Main Results:
- Heart failure medications were more common in patients with severe cardiac phenotypes.
- Beta-blockers (55.4%) and ACEis/ARBs (57.4%) had high discontinuation rates (21.7% and 32.9%, respectively).
- MRAs (39.0%) had low discontinuation rates (7.5%) and were linked to reduced mortality (HR 0.77; P < .001).
- Low-dose beta-blockers reduced mortality in patients with LVEF ≤40% (HR 0.61; P = .002).
- No significant association was found for ACEi/ARBs with mortality.
Conclusions:
- Conventional heart failure medications are underutilized in ATTR-CA.
- MRAs demonstrate a significant survival benefit in ATTR-CA patients.
- Low-dose beta-blockers may improve survival in specific patient subgroups (LVEF ≤40%).
- Findings for MRAs and beta-blockers warrant confirmation through prospective randomized controlled trials.
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