Heart failure & cardiomyopathiesCohort study
Conventional heart failure therapy in cardiac ATTR amyloidosis
- Retrospective cohort study
- propensity-score matched
- single-centre
Authors' 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
Study context
- Population
- Consecutive patients diagnosed with transthyretin cardiac amyloidosis (ATTR-CA) at the National Amyloidosis Centre, 2000–2022
- Participants
- 2,371 patients
- Exposure
- Conventional HF medications vs no treatment
- Outcome
- Prescription patterns, dosages, discontinuation rates and association with prognosis (mortality) of conventional HF medications
- Follow-up
- Median 27.8 months (IQR 10.6-51.3)
Main finding
As reported in the abstract
Mortality with MRAs and beta-blockers (propensity score-matched)
Hazard ratio (95% CI)P value
MRAsoverall population
0.77(0.66–0.89)
P < 0.001MRAspre-specified subgroup LVEF >40%
0.75(0.63–0.90)
P = 0.002Low-dose beta-blockerspre-specified subgroup LVEF ≤40%
0.61(0.45–0.83)
P = 0.002Observational data: associations, not effects.
Further findings
| Outcome | Values |
|---|---|
| Prescription of HF medications (greater with more severe cardiac phenotype) | Beta-blockers 55.4% · ACEi/ARBs 57.4% · MRAs 39.0% |
| Discontinuation · median follow-up 27.8 months | Beta-blockers 21.7% · ACEi/ARBs 32.9% · MRAs 7.5% |
Original publication
Conventional heart failure therapy in cardiac ATTR amyloidosis. Eur Heart J. Published 22 May 2023. doi:10.1093/eurheartj/ehad347
Summarised from the published abstract; every number is checked against it