Conventional heart failure therapy in cardiac ATTR amyloidosis
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 and results A retrospective analysis of all consec...
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| Veröffentlicht in: | European heart journal 2023-08, Vol.44 (31), p.2893-2907 |
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| creator | Ioannou, Adam Massa, Paolo Patel, Rishi K Razvi, Yousuf Porcari, Aldostefano Rauf, Muhammad U Jiang, Anita Cabras, Giacomo Filisetti, Stefano Bolhuis, Roos E Bandera, Francesco Venneri, Lucia Martinez-Naharro, Ana Law, Steven Kotecha, Tushar Virsinskaite, Ruta Knight, Daniel S Emdin, Michele Petrie, Aviva Lachmann, Helen Wechelakar, Ashutosh Petrie, Mark Hughes, Alun Freemantle, Nick Hawkins, Philip N Whelan, Carol McMurray, John J V Gillmore, Julian D Fontana, Marianna |
| description | 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 and results
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.
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.
Structured Graphical Abstract
Structured Graphical Abstract
Discontinuation rates of heart failure medications in patients with cardiac ATTR amyloidosis. Kaplan–Meier curves comparing survival in patients treated with heart failure medications to propensity score-matched patients not treated with heart failure medications, followed by a Cox proportional hazards regression analysis. AC |
| doi_str_mv | 10.1093/eurheartj/ehad347 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10424879</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/eurheartj/ehad347</oup_id><sourcerecordid>2818055023</sourcerecordid><originalsourceid>FETCH-LOGICAL-c437t-3b5c5a460d2ccb5ec2485b675fbdd9e76164ad210bbb121eeb9021284ab4cdbb3</originalsourceid><addsrcrecordid>eNqNkEtLAzEUhYMotlZ_gBuZpQvHJplkHhulFF9QEKSCu5DXOCkzkzGZKfTfG20tunN14d5zvns4AJwjeI1gkUz14CrNXb-a6oqrhGQHYIwoxnGREnoIxhAVNE7T_G0ETrxfQQjzFKXHYJRkGIU9GYObuW3Xuu2NbXkdfdOikpt6cDrqK-14t4lMG0nulOEymi2XLxFvNrU1ynrjT8FRyWuvz3ZzAl7v75bzx3jx_PA0ny1iSZKsjxNBJeUkhQpLKaiWmORUpBkthVKFzkIqwhVGUAiBMNJaFBAjnBMuiFRCJBNwu-V2g2i0kiGx4zXrnGm42zDLDft7aU3F3u2aIUjCr6wIhMsdwdmPQfueNcZLXde81XbwDOcoh5RCnAQp2kqls947Xe7_IMi-imf74tmu-OC5-B1w7_hpOgiutgI7dP_gfQIrJ5Qa</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2818055023</pqid></control><display><type>article</type><title>Conventional heart failure therapy in cardiac ATTR amyloidosis</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Ioannou, Adam ; Massa, Paolo ; Patel, Rishi K ; Razvi, Yousuf ; Porcari, Aldostefano ; Rauf, Muhammad U ; Jiang, Anita ; Cabras, Giacomo ; Filisetti, Stefano ; Bolhuis, Roos E ; Bandera, Francesco ; Venneri, Lucia ; Martinez-Naharro, Ana ; Law, Steven ; Kotecha, Tushar ; Virsinskaite, Ruta ; Knight, Daniel S ; Emdin, Michele ; Petrie, Aviva ; Lachmann, Helen ; Wechelakar, Ashutosh ; Petrie, Mark ; Hughes, Alun ; Freemantle, Nick ; Hawkins, Philip N ; Whelan, Carol ; McMurray, John J V ; Gillmore, Julian D ; Fontana, Marianna</creator><creatorcontrib>Ioannou, Adam ; Massa, Paolo ; Patel, Rishi K ; Razvi, Yousuf ; Porcari, Aldostefano ; Rauf, Muhammad U ; Jiang, Anita ; Cabras, Giacomo ; Filisetti, Stefano ; Bolhuis, Roos E ; Bandera, Francesco ; Venneri, Lucia ; Martinez-Naharro, Ana ; Law, Steven ; Kotecha, Tushar ; Virsinskaite, Ruta ; Knight, Daniel S ; Emdin, Michele ; Petrie, Aviva ; Lachmann, Helen ; Wechelakar, Ashutosh ; Petrie, Mark ; Hughes, Alun ; Freemantle, Nick ; Hawkins, Philip N ; Whelan, Carol ; McMurray, John J V ; Gillmore, Julian D ; Fontana, Marianna</creatorcontrib><description>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 and results
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.
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.
Structured Graphical Abstract
Structured Graphical Abstract
Discontinuation rates of heart failure medications in patients with cardiac ATTR amyloidosis. Kaplan–Meier curves comparing survival in patients treated with heart failure medications to propensity score-matched patients not treated with heart failure medications, followed by a Cox proportional hazards regression analysis. ACEi, angiotensin-converting enzyme inhibitor; ARBs, angiotensin II receptor blockers; MRAs, mineralocorticoid receptor antagonists; LVEF, left ventricular ejection fraction; HR, hazard ratio; CI, confidence interval.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehad347</identifier><identifier>PMID: 37216684</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Adrenergic beta-Antagonists - therapeutic use ; Angiotensin Receptor Antagonists - therapeutic use ; Angiotensin-Converting Enzyme Inhibitors ; Fast Track Clinical Research ; Heart Failure - drug therapy ; Heart Failure - etiology ; Humans ; Prospective Studies ; Retrospective Studies ; Stroke Volume ; Ventricular Function, Left</subject><ispartof>European heart journal, 2023-08, Vol.44 (31), p.2893-2907</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. 2023</rights><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c437t-3b5c5a460d2ccb5ec2485b675fbdd9e76164ad210bbb121eeb9021284ab4cdbb3</citedby><cites>FETCH-LOGICAL-c437t-3b5c5a460d2ccb5ec2485b675fbdd9e76164ad210bbb121eeb9021284ab4cdbb3</cites><orcidid>0000-0001-5807-5740 ; 0000-0002-0512-3961 ; 0000-0001-6174-9232 ; 0000-0002-9233-9831 ; 0000-0001-5017-8657 ; 0000-0002-9335-5526 ; 0000-0003-4766-3293 ; 0000-0002-5236-4741 ; 0000-0003-0059-4817 ; 0000-0001-5432-5271</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37216684$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ioannou, Adam</creatorcontrib><creatorcontrib>Massa, Paolo</creatorcontrib><creatorcontrib>Patel, Rishi K</creatorcontrib><creatorcontrib>Razvi, Yousuf</creatorcontrib><creatorcontrib>Porcari, Aldostefano</creatorcontrib><creatorcontrib>Rauf, Muhammad U</creatorcontrib><creatorcontrib>Jiang, Anita</creatorcontrib><creatorcontrib>Cabras, Giacomo</creatorcontrib><creatorcontrib>Filisetti, Stefano</creatorcontrib><creatorcontrib>Bolhuis, Roos E</creatorcontrib><creatorcontrib>Bandera, Francesco</creatorcontrib><creatorcontrib>Venneri, Lucia</creatorcontrib><creatorcontrib>Martinez-Naharro, Ana</creatorcontrib><creatorcontrib>Law, Steven</creatorcontrib><creatorcontrib>Kotecha, Tushar</creatorcontrib><creatorcontrib>Virsinskaite, Ruta</creatorcontrib><creatorcontrib>Knight, Daniel S</creatorcontrib><creatorcontrib>Emdin, Michele</creatorcontrib><creatorcontrib>Petrie, Aviva</creatorcontrib><creatorcontrib>Lachmann, Helen</creatorcontrib><creatorcontrib>Wechelakar, Ashutosh</creatorcontrib><creatorcontrib>Petrie, Mark</creatorcontrib><creatorcontrib>Hughes, Alun</creatorcontrib><creatorcontrib>Freemantle, Nick</creatorcontrib><creatorcontrib>Hawkins, Philip N</creatorcontrib><creatorcontrib>Whelan, Carol</creatorcontrib><creatorcontrib>McMurray, John J V</creatorcontrib><creatorcontrib>Gillmore, Julian D</creatorcontrib><creatorcontrib>Fontana, Marianna</creatorcontrib><title>Conventional heart failure therapy in cardiac ATTR amyloidosis</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>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 and results
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.
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.
Structured Graphical Abstract
Structured Graphical Abstract
Discontinuation rates of heart failure medications in patients with cardiac ATTR amyloidosis. Kaplan–Meier curves comparing survival in patients treated with heart failure medications to propensity score-matched patients not treated with heart failure medications, followed by a Cox proportional hazards regression analysis. ACEi, angiotensin-converting enzyme inhibitor; ARBs, angiotensin II receptor blockers; MRAs, mineralocorticoid receptor antagonists; LVEF, left ventricular ejection fraction; HR, hazard ratio; CI, confidence interval.</description><subject>Adrenergic beta-Antagonists - therapeutic use</subject><subject>Angiotensin Receptor Antagonists - therapeutic use</subject><subject>Angiotensin-Converting Enzyme Inhibitors</subject><subject>Fast Track Clinical Research</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - etiology</subject><subject>Humans</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Stroke Volume</subject><subject>Ventricular Function, Left</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><recordid>eNqNkEtLAzEUhYMotlZ_gBuZpQvHJplkHhulFF9QEKSCu5DXOCkzkzGZKfTfG20tunN14d5zvns4AJwjeI1gkUz14CrNXb-a6oqrhGQHYIwoxnGREnoIxhAVNE7T_G0ETrxfQQjzFKXHYJRkGIU9GYObuW3Xuu2NbXkdfdOikpt6cDrqK-14t4lMG0nulOEymi2XLxFvNrU1ynrjT8FRyWuvz3ZzAl7v75bzx3jx_PA0ny1iSZKsjxNBJeUkhQpLKaiWmORUpBkthVKFzkIqwhVGUAiBMNJaFBAjnBMuiFRCJBNwu-V2g2i0kiGx4zXrnGm42zDLDft7aU3F3u2aIUjCr6wIhMsdwdmPQfueNcZLXde81XbwDOcoh5RCnAQp2kqls947Xe7_IMi-imf74tmu-OC5-B1w7_hpOgiutgI7dP_gfQIrJ5Qa</recordid><startdate>20230814</startdate><enddate>20230814</enddate><creator>Ioannou, Adam</creator><creator>Massa, Paolo</creator><creator>Patel, Rishi K</creator><creator>Razvi, Yousuf</creator><creator>Porcari, Aldostefano</creator><creator>Rauf, Muhammad U</creator><creator>Jiang, Anita</creator><creator>Cabras, Giacomo</creator><creator>Filisetti, Stefano</creator><creator>Bolhuis, Roos E</creator><creator>Bandera, Francesco</creator><creator>Venneri, Lucia</creator><creator>Martinez-Naharro, Ana</creator><creator>Law, Steven</creator><creator>Kotecha, Tushar</creator><creator>Virsinskaite, Ruta</creator><creator>Knight, Daniel S</creator><creator>Emdin, Michele</creator><creator>Petrie, Aviva</creator><creator>Lachmann, Helen</creator><creator>Wechelakar, Ashutosh</creator><creator>Petrie, Mark</creator><creator>Hughes, Alun</creator><creator>Freemantle, Nick</creator><creator>Hawkins, Philip N</creator><creator>Whelan, Carol</creator><creator>McMurray, John J V</creator><creator>Gillmore, Julian D</creator><creator>Fontana, Marianna</creator><general>Oxford University Press</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5807-5740</orcidid><orcidid>https://orcid.org/0000-0002-0512-3961</orcidid><orcidid>https://orcid.org/0000-0001-6174-9232</orcidid><orcidid>https://orcid.org/0000-0002-9233-9831</orcidid><orcidid>https://orcid.org/0000-0001-5017-8657</orcidid><orcidid>https://orcid.org/0000-0002-9335-5526</orcidid><orcidid>https://orcid.org/0000-0003-4766-3293</orcidid><orcidid>https://orcid.org/0000-0002-5236-4741</orcidid><orcidid>https://orcid.org/0000-0003-0059-4817</orcidid><orcidid>https://orcid.org/0000-0001-5432-5271</orcidid></search><sort><creationdate>20230814</creationdate><title>Conventional heart failure therapy in cardiac ATTR amyloidosis</title><author>Ioannou, Adam ; Massa, Paolo ; Patel, Rishi K ; Razvi, Yousuf ; Porcari, Aldostefano ; Rauf, Muhammad U ; Jiang, Anita ; Cabras, Giacomo ; Filisetti, Stefano ; Bolhuis, Roos E ; Bandera, Francesco ; Venneri, Lucia ; Martinez-Naharro, Ana ; Law, Steven ; Kotecha, Tushar ; Virsinskaite, Ruta ; Knight, Daniel S ; Emdin, Michele ; Petrie, Aviva ; Lachmann, Helen ; Wechelakar, Ashutosh ; Petrie, Mark ; Hughes, Alun ; Freemantle, Nick ; Hawkins, Philip N ; Whelan, Carol ; McMurray, John J V ; Gillmore, Julian D ; Fontana, Marianna</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c437t-3b5c5a460d2ccb5ec2485b675fbdd9e76164ad210bbb121eeb9021284ab4cdbb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adrenergic beta-Antagonists - therapeutic use</topic><topic>Angiotensin Receptor Antagonists - therapeutic use</topic><topic>Angiotensin-Converting Enzyme Inhibitors</topic><topic>Fast Track Clinical Research</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - etiology</topic><topic>Humans</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>Stroke Volume</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ioannou, Adam</creatorcontrib><creatorcontrib>Massa, Paolo</creatorcontrib><creatorcontrib>Patel, Rishi K</creatorcontrib><creatorcontrib>Razvi, Yousuf</creatorcontrib><creatorcontrib>Porcari, Aldostefano</creatorcontrib><creatorcontrib>Rauf, Muhammad U</creatorcontrib><creatorcontrib>Jiang, Anita</creatorcontrib><creatorcontrib>Cabras, Giacomo</creatorcontrib><creatorcontrib>Filisetti, Stefano</creatorcontrib><creatorcontrib>Bolhuis, Roos E</creatorcontrib><creatorcontrib>Bandera, Francesco</creatorcontrib><creatorcontrib>Venneri, Lucia</creatorcontrib><creatorcontrib>Martinez-Naharro, Ana</creatorcontrib><creatorcontrib>Law, Steven</creatorcontrib><creatorcontrib>Kotecha, Tushar</creatorcontrib><creatorcontrib>Virsinskaite, Ruta</creatorcontrib><creatorcontrib>Knight, Daniel S</creatorcontrib><creatorcontrib>Emdin, Michele</creatorcontrib><creatorcontrib>Petrie, Aviva</creatorcontrib><creatorcontrib>Lachmann, Helen</creatorcontrib><creatorcontrib>Wechelakar, Ashutosh</creatorcontrib><creatorcontrib>Petrie, Mark</creatorcontrib><creatorcontrib>Hughes, Alun</creatorcontrib><creatorcontrib>Freemantle, Nick</creatorcontrib><creatorcontrib>Hawkins, Philip N</creatorcontrib><creatorcontrib>Whelan, Carol</creatorcontrib><creatorcontrib>McMurray, John J V</creatorcontrib><creatorcontrib>Gillmore, Julian D</creatorcontrib><creatorcontrib>Fontana, Marianna</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ioannou, Adam</au><au>Massa, Paolo</au><au>Patel, Rishi K</au><au>Razvi, Yousuf</au><au>Porcari, Aldostefano</au><au>Rauf, Muhammad U</au><au>Jiang, Anita</au><au>Cabras, Giacomo</au><au>Filisetti, Stefano</au><au>Bolhuis, Roos E</au><au>Bandera, Francesco</au><au>Venneri, Lucia</au><au>Martinez-Naharro, Ana</au><au>Law, Steven</au><au>Kotecha, Tushar</au><au>Virsinskaite, Ruta</au><au>Knight, Daniel S</au><au>Emdin, Michele</au><au>Petrie, Aviva</au><au>Lachmann, Helen</au><au>Wechelakar, Ashutosh</au><au>Petrie, Mark</au><au>Hughes, Alun</au><au>Freemantle, Nick</au><au>Hawkins, Philip N</au><au>Whelan, Carol</au><au>McMurray, John J V</au><au>Gillmore, Julian D</au><au>Fontana, Marianna</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Conventional heart failure therapy in cardiac ATTR amyloidosis</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2023-08-14</date><risdate>2023</risdate><volume>44</volume><issue>31</issue><spage>2893</spage><epage>2907</epage><pages>2893-2907</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>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 and results
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.
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.
Structured Graphical Abstract
Structured Graphical Abstract
Discontinuation rates of heart failure medications in patients with cardiac ATTR amyloidosis. Kaplan–Meier curves comparing survival in patients treated with heart failure medications to propensity score-matched patients not treated with heart failure medications, followed by a Cox proportional hazards regression analysis. ACEi, angiotensin-converting enzyme inhibitor; ARBs, angiotensin II receptor blockers; MRAs, mineralocorticoid receptor antagonists; LVEF, left ventricular ejection fraction; HR, hazard ratio; CI, confidence interval.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>37216684</pmid><doi>10.1093/eurheartj/ehad347</doi><tpages>15</tpages><orcidid>https://orcid.org/0000-0001-5807-5740</orcidid><orcidid>https://orcid.org/0000-0002-0512-3961</orcidid><orcidid>https://orcid.org/0000-0001-6174-9232</orcidid><orcidid>https://orcid.org/0000-0002-9233-9831</orcidid><orcidid>https://orcid.org/0000-0001-5017-8657</orcidid><orcidid>https://orcid.org/0000-0002-9335-5526</orcidid><orcidid>https://orcid.org/0000-0003-4766-3293</orcidid><orcidid>https://orcid.org/0000-0002-5236-4741</orcidid><orcidid>https://orcid.org/0000-0003-0059-4817</orcidid><orcidid>https://orcid.org/0000-0001-5432-5271</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0195-668X |
| ispartof | European heart journal, 2023-08, Vol.44 (31), p.2893-2907 |
| issn | 0195-668X 1522-9645 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10424879 |
| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adrenergic beta-Antagonists - therapeutic use Angiotensin Receptor Antagonists - therapeutic use Angiotensin-Converting Enzyme Inhibitors Fast Track Clinical Research Heart Failure - drug therapy Heart Failure - etiology Humans Prospective Studies Retrospective Studies Stroke Volume Ventricular Function, Left |
| title | Conventional heart failure therapy in cardiac ATTR amyloidosis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-08T09%3A45%3A52IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Conventional%20heart%20failure%20therapy%20in%20cardiac%20ATTR%20amyloidosis&rft.jtitle=European%20heart%20journal&rft.au=Ioannou,%20Adam&rft.date=2023-08-14&rft.volume=44&rft.issue=31&rft.spage=2893&rft.epage=2907&rft.pages=2893-2907&rft.issn=0195-668X&rft.eissn=1522-9645&rft_id=info:doi/10.1093/eurheartj/ehad347&rft_dat=%3Cproquest_pubme%3E2818055023%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2818055023&rft_id=info:pmid/37216684&rft_oup_id=10.1093/eurheartj/ehad347&rfr_iscdi=true |