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

• Published in: ESC Heart Failure Vol. 8; no. 4; pp. 3369 - 3374
• Main Authors: Tini, Giacomo, Cappelli, Francesco, Biagini, Elena, Musumeci, Beatrice, Merlo, Marco, Crotti, Lia, Cameli, Matteo, Di Bella, Gianluca, Cipriani, Alberto, Marzo, Francesca, Guerra, Federico, Forleo, Cinzia, Gagliardi, Christian, Zampieri, Mattia, Carigi, Samuela, Vianello, Pier Filippo, Mandoli, Giulia Elena, Ciliberti, Giuseppe, Lichelli, Luca, Mariani, Davide, Porcari, Aldostefano, Russo, Domitilla, Licordari, Roberto, Ponziani, Alberto, Porto, Italo, Perfetto, Federico, Autore, Camillo, Rapezzi, Claudio, Sinagra, Giafranco, Canepa, Marco
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01-08-2021; John Wiley and Sons Inc; Wiley
• Subjects: Amyloidosis; Beta blockers; Blood pressure; Cardiac amyloidosis; Cardiac arrhythmia; Cardiovascular disease; Coronary vessels; Etiology; Heart failure; Heart rate; Hypertension; Light chains; Morbidity; Pathophysiology; Population; Short Communication; Short Communications; Transthyretin; Heart failure; Beta-blockers; Cardiac amyloidosis; Light chains; Transthyretin
• ISSN: 2055-5822; 2055-5822
• DOI: 10.1002/ehf2.13411

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 One‐hundred‐nineteen patients (19%) who were on beta‐blocker at first evaluation had this therapy withdrawn, mainly because of intolerance in the presence of heart failure with advanced diastolic dysfunction.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