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 One-hundred-nineteen patients (19%) who were on beta-blocker at first evaluation had this therapy withdrawn, mainly because of intolerance in the presence of heart failure with advanced diastolic dysfunction.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.

Current patterns of beta-blocker prescription in cardiac amyloidosis. an Italian nationwide survey / Tini, G.; Cappelli, F.; Biagini, E.; Musumeci, B.; Merlo, M.; Crotti, L.; Cameli, M.; Di Bella, G.; Cipriani, A.; Marzo, F.; Guerra, F.; Forleo, C.; Gagliardi, C.; Zampieri, Mattia; Carigi, S.; Vianello, P. F.; Mandoli, G. E.; Ciliberti, G.; Lichelli, L.; Mariani, D.; Porcari, A.; Russo, D.; Licordari, R.; Ponziani, A.; Porto, I.; Perfetto, F.; Autore, C.; Rapezzi, C.; Sinagra, G.; Canepa, M.. - In: ESC HEART FAILURE. - ISSN 2055-5822. - 8:4(2021), pp. 1-6. [10.1002/ehf2.13411]

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

Tini G.;Musumeci B.;Merlo M.;Cameli M.;Forleo C.;Gagliardi C.;Russo D.;Autore C.;Canepa M.
2021

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.
2021
beta-blockers; cardiac amyloidosis; heart failure; light chains; transthyretin
01 Pubblicazione su rivista::01a Articolo in rivista
Current patterns of beta-blocker prescription in cardiac amyloidosis. an Italian nationwide survey / Tini, G.; Cappelli, F.; Biagini, E.; Musumeci, B.; Merlo, M.; Crotti, L.; Cameli, M.; Di Bella, G.; Cipriani, A.; Marzo, F.; Guerra, F.; Forleo, C.; Gagliardi, C.; Zampieri, Mattia; Carigi, S.; Vianello, P. F.; Mandoli, G. E.; Ciliberti, G.; Lichelli, L.; Mariani, D.; Porcari, A.; Russo, D.; Licordari, R.; Ponziani, A.; Porto, I.; Perfetto, F.; Autore, C.; Rapezzi, C.; Sinagra, G.; Canepa, M.. - In: ESC HEART FAILURE. - ISSN 2055-5822. - 8:4(2021), pp. 1-6. [10.1002/ehf2.13411]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1576533
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