{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T04:41:59Z","timestamp":1760589719861,"version":"build-2065373602"},"reference-count":23,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:00:00Z","timestamp":1760140800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006400","name":"Alnylam","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100006400","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Conventional HF treatment in transthyretin cardiac amyloidosis (ATTR-CA) resulting in restrictive cardiomyopathy is debated due to absent trial evidence in this specific sub-population of heart failure (HF) patients. Current European Society of Cardiology guidelines recommend the use of diuretics and mineralocorticoid receptor antagonists (MRAs). However, beta-blockers (BBs) and angiotensin-converting enzyme inhibitors\/angiotensin II receptor blockers (ACEi\/ARBs) are often discontinued due to hypotension or bradycardia. This study assesses real-world HF treatment patterns and their impact on survival in a multinational ATTR-CA cohort. Methods: A retrospective analysis of 794 ATTR-CA patients examined baseline BB, ACEi\/ARB, and MRA prescriptions. The cohort was divided based on guideline publication dates. Results: Patients were predominantly male (73.2%) with a median age of 78 years. Prescription of diuretics (52.8%) and disease-modifying therapy (44.9%), mostly tafamidis, was common. BBs (43.7%) and ACEi\/ARBs (41.2%) were prescribed more often in patients with higher NYHA class, elevated NT-proBNP, and more comorbidities. Blood pressure and heart rate were similar regardless of BB or ACEi\/ARB use. BB prescription and combination therapy with BB and ACEi\/ARB increased over time. Neither BB nor ACEi\/ARB use significantly impacted mortality when analyzed in a multivariate Cox proportional hazard regression. Conclusions: Use of BBs and ACEi\/ARBs has increased over time, particularly in advanced-stage ATTR-CA patients, and although these therapies appear to be reasonably tolerated, survival was not significantly altered.<\/jats:p>","DOI":"10.3390\/jcdd12100403","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T06:06:32Z","timestamp":1760508392000},"page":"403","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends in Conventional Heart Failure Therapy in a Real-World Multinational ATTR-CA Cohort"],"prefix":"10.3390","volume":"12","author":[{"given":"Eva H.","family":"van der Geest","sequence":"first","affiliation":[{"name":"Department of Cardiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7208-5769","authenticated-orcid":false,"given":"Nina","family":"Ajmone Marsan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8906-2395","authenticated-orcid":false,"given":"Dorien","family":"Laenens","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1196-3016","authenticated-orcid":false,"given":"Philippe J. M. R.","family":"Debonnaire","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sint-Jan Hospital Bruges, 8000 Bruges, Belgium"}]},{"given":"Mathias","family":"Claeys","sequence":"additional","affiliation":[{"name":"Department of Cardiology, AZ Groeninge, 8500 Kortrijk, Belgium"}]},{"given":"Fauto","family":"Pinto","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centro Hospitalar Universit\u00e1rio Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"given":"Dulce","family":"Brito","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centro Hospitalar Universit\u00e1rio Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2677-3389","authenticated-orcid":false,"given":"Erwan","family":"Donal","sequence":"additional","affiliation":[{"name":"Cardiologie, CHU de Rennes, Universit\u00e9 de Rennes, F-35000 Rennes, France"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3985-3249","authenticated-orcid":false,"given":"Steven","family":"Droogmans","sequence":"additional","affiliation":[{"name":"Centrum voor Hart-en Vaatziekten (CHVZ), Dienst Cardiologie, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5154-1101","authenticated-orcid":false,"given":"Nico","family":"Van de Veire","sequence":"additional","affiliation":[{"name":"Department of Cardiology, AZ Maria Middelares, 3600 Gent, Belgium"}]},{"given":"Philippe","family":"Bertrand","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Oost-Limburg, 3600 Genk, Belgium"}]},{"given":"Takeru","family":"Nabeta","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kitasato University School of Medicine, Sagamihara 8500, Japan"}]},{"given":"Francesca","family":"Graziani","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Cardiovascolari-CUORE, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1562-8365","authenticated-orcid":false,"given":"Madelien V.","family":"Regeer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1186\/s13023-023-02962-5","article-title":"A 15-year consolidated overview of data in over 6000 patients from the Transthyretin Amyloidosis Outcomes Survey (THAOS)","volume":"18","author":"Gentile","year":"2023","journal-title":"Orphanet J. 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