| Autor: |
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 |
| Předmět: |
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| Zdroj: |
European Heart Journal; 8/14/2023, Vol. 44 Issue 31, p2893-2907, 15p |
| Abstrakt: |
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. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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