{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T22:46:30Z","timestamp":1794264390492,"version":"4.9.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"31","license":[{"start":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T00:00:00Z","timestamp":1684713600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>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).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>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\u201351.3), 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\u20130.89), P &amp;lt; .001] and in a pre-specified subgroup of patients with a left ventricular ejection fraction (LVEF) &amp;gt;40% [HR 0.75 (95% CI 0.63\u20130.90), 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 \u226440% [HR 0.61 (95% CI 0.45\u20130.83), P = .002]. No convincing differences were found for treatment with ACEi\/ARBs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>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 \u226440%. 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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehad347","type":"journal-article","created":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T21:35:58Z","timestamp":1684791358000},"page":"2893-2907","source":"Crossref","is-referenced-by-count":159,"title":["Conventional heart failure therapy in cardiac ATTR amyloidosis"],"prefix":"10.1093","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5017-8657","authenticated-orcid":false,"given":"Adam","family":"Ioannou","sequence":"first","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Massa","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishi K","family":"Patel","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4766-3293","authenticated-orcid":false,"given":"Yousuf","family":"Razvi","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldostefano","family":"Porcari","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"},{"name":"Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Via Giacomo Puccini, Trieste 34100 , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad U","family":"Rauf","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Jiang","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Cabras","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Filisetti","sequence":"additional","affiliation":[{"name":"Cardiology University Department, IRCCS Policlinico San Donato , Piazza Edmondo Malan, Milan 20097 , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roos E","family":"Bolhuis","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Bandera","sequence":"additional","affiliation":[{"name":"Cardiology University Department, IRCCS Policlinico San Donato , Piazza Edmondo Malan, Milan 20097 , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Venneri","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Martinez-Naharro","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9335-5526","authenticated-orcid":false,"given":"Steven","family":"Law","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0059-4817","authenticated-orcid":false,"given":"Tushar","family":"Kotecha","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruta","family":"Virsinskaite","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0512-3961","authenticated-orcid":false,"given":"Daniel S","family":"Knight","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Emdin","sequence":"additional","affiliation":[{"name":"Health Science Interdisciplinary Center, Scuola Superiore Sant\u2019Anna , Via Giuseppe Moruzzi, Pisa 56127 , Italy"},{"name":"Cardiovascular Department, Fondazione Toscana Gabriele Monasterio , Via Giuseppe Moruzzi, Pisa 56124 , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5236-4741","authenticated-orcid":false,"given":"Aviva","family":"Petrie","sequence":"additional","affiliation":[{"name":"Biostatistics Unit, University College London Eastman Dental Institute , 256 Grays Inn Road, London WC1X 8LD , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Lachmann","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashutosh","family":"Wechelakar","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , 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University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Whelan","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J V","family":"McMurray","sequence":"additional","affiliation":[{"name":"BHF Cardiovascular Research Centre, University of Glasgow , 126 University Pl, Glasgow G12 8TA , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6174-9232","authenticated-orcid":false,"given":"Julian D","family":"Gillmore","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, University College London, Royal Free Campus , Rowland Hill Street, London NW3 2PF , 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