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. 2021 Aug;8(4):3369-3374.
doi: 10.1002/ehf2.13411. Epub 2021 May 14.

Current patterns of beta-blocker prescription in cardiac amyloidosis: an Italian nationwide survey

Giacomo Tini  1   2 , Francesco Cappelli  3 , Elena Biagini  4 , Beatrice Musumeci  2 , Marco Merlo  5 , Lia Crotti  6 , Matteo Cameli  7 , Gianluca Di Bella  8 , Alberto Cipriani  9 , Francesca Marzo  10 , Federico Guerra  11 , Cinzia Forleo  12 , Christian Gagliardi  4 , Mattia Zampieri  3 , Samuela Carigi  10 , Pier Filippo Vianello  1 , Giulia Elena Mandoli  7 , Giuseppe Ciliberti  11 , Luca Lichelli  9 , Davide Mariani  6 , Aldostefano Porcari  5 , Domitilla Russo  2 , Roberto Licordari  8 , Alberto Ponziani  4 , Italo Porto  1   13 , Federico Perfetto  3 , Camillo Autore  2 , Claudio Rapezzi  14   15 , Giafranco Sinagra  5 , Marco Canepa  1   13
Affiliations

Current patterns of beta-blocker prescription in cardiac amyloidosis: an Italian nationwide survey

Giacomo Tini et al. ESC Heart Fail. 2021 Aug.

Abstract

Aims: The use of beta-blocker therapy in cardiac amyloidosis (CA) is debated. We aimed at describing patterns of beta-blocker prescription through a nationwide survey.

Methods and results: From 11 referral centres, we retrospectively collected data of CA patients with a first evaluation after 2016 (n = 642). Clinical characteristics at first and last evaluation were collected, with a focus on medical therapy. For patients in whom beta-blocker therapy was started, stopped, or continued between first and last evaluation, the main reason for beta-blocker management was requested. Median age of study population was 77 years; 81% were men. Arterial hypertension was found in 58% of patients, atrial fibrillation (AF) in 57%, and coronary artery disease in 16%. Left ventricular ejection fraction was preserved in 62% of cases, and 74% of patients had advanced diastolic dysfunction. Out of the 250 CA patients on beta-blockers at last evaluation, 215 (33%) were already taking this therapy at first evaluation, while 35 (5%) were started it, in both cases primarily because of high-rate AF. One-hundred-nineteen patients (19%) who were on beta-blocker at first evaluation had this therapy withdrawn, mainly because of intolerance in the presence of heart failure with advanced diastolic dysfunction. The remaining 273 patients (43%) had never received beta-blocker therapy. Beta-blockers usage was similar between CA aetiologies. Patients taking vs. not taking beta-blockers differed only for a greater prevalence of arterial hypertension, coronary artery disease, AF, and non-restrictive filling pattern (P < 0.01 for all) in the former group.

Conclusions: Beta-blockers prescription is not infrequent in CA. Such therapy may be tolerated in the presence of co-morbidities for which beta-blockers are routinely used and in the absence of advanced diastolic dysfunction.

Keywords: Beta-blockers; Cardiac amyloidosis; Heart failure; Light chains; Transthyretin.

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Conflict of interest statement

All authors declare they have no conflict of interest in relation to this study.

Figures

Figure 1
Figure 1
Patterns of beta‐blocker therapy prescription.
See this image and copyright information in PMC

References

    1. Gilstrap LG, Dominici F, Wang Y, El‐Sady MS, Singh A, Di Carli MF, Falk RH, Dorbala S. Epidemiology of cardiac amyloidosis‐associated heart failure hospitalizations among fee‐for‐service medicare beneficiaries in the United States. Circ Heart Fail 2019; 12: e005407. - PMC - PubMed
    1. Falk RH, Alexander KM, Liao R, Dorbala S. AL (light‐chain) cardiac amyloidosis: a review of diagnosis and therapy. J Am Coll Cardiol 2016; 68: 1323–1341. - PubMed
    1. Gertz MA, Benson MD, Dyck PJ, Grogan M, Coelho T, Cruz M, Berk JL, Plante‐Bordeneuve V, Schmidt HHJ, Merlini G. Diagnosis, prognosis, and therapy of transthyretin amyloidosis. J Am Coll Cardiol 2015; 66: 2451–2466. - PubMed
    1. Cappelli F, Vignini E, Martone R, Perlini S, Mussinelli R, Sabena A, Morini S, Gabriele M, Taborchi G, Bartolini S, Lossi A, Nardi G, Marchionni N, Di Mario C, Olivotto I, Perfetto F. Baseline ECG features and arrhythmic profile in transthyretin versus light chain cardiac amyloidosis. Circ Heart Fail 2020; 13: e006619. - PubMed
    1. Cappelli F, Tini G, Russo D, Emdin M, Del Franco A, Vergaro G, Di Bella G, Mazzeo A, Canepa M, Volpe M, Perfetto F, Autore C, Di Mario C, Rapezzi C, Musumeci MB. Arterial thrombo‐embolic events in cardiac amyloidosis: a look beyond atrial fibrillation. Amyloid 2021; 28: 12–18. - PubMed