Traditional Heart Failure Therapies Do Not Increase Survival in ATTR-CM

Traditional heart failure therapies including beta blockers, angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB), do not confer benefit and beta blockers may be associated with harm in transthyretin cardiac amyloidosis, according to research results presented at the American College of Cardiology (ACC) 2021 Annual Meeting, held virtually May 15 to May 17, 2021.

Researchers evaluated the relationship between beta blockers, ACEi/ARB blockade, and mineralocorticoid receptor antagonist (MRA) use with survival in patients with transthyretin cardiac amyloidosis (ATTR-CM). The cohort included 309 consecutive patients (median age, 75.0 years; 84.1% men; 17.2% with atrial fibrillation or flutter) with ATTR-CM; exposure was each class of heart failure medication and the primary outcome was all-cause mortality. Investigators also evaluated the effects of stopping beta blocker therapy during the follow-up period.

At baseline, 49.8% of patients were taking beta blockers, 35% were on ACEi/ARB therapies, and 23.9% were on MRAs. Within the cohort, investigators noted a trend towards harm with beta blocker use, seen in the unadjusted model. Interaction was significant between beta blocker therapy and risk score, with low-risk patients demonstrating a greater than 4-fold increase in all-cause mortality.

No interaction between beta blocker use and left ventricular ejection fraction and all-cause mortality was noted.

Among patients on beta blockers at baseline, stopping beta blocker therapy was associated with improved rates of survival; no association between all-cause mortality and ACEi/ARB or MRA use was noted after adjustment.

“There was no benefit for traditional [heart failure] therapies in ATTR-CM, with a signal of harm with [beta blockers] in the low-risk group,” the researchers concluded. “Stopping [beta blockers] appeared to improve survival.”

Reference

Cheng RK-H, Vasbinder A, Levy W, et al. Association of traditional heart failure therapies with survival in transthyretin cardiac amyloidosis. Presented at: American College of Cardiology (ACC) Annual Meeting; May 15-17, 2021. Abstract 1032-07.