Abstract
Abstract only Background: Randomized controlled trials have demonstrated mortality benefit for several medication classes in patients with heart failure (HF), especially with reduced ejection fraction. However, the benefit of these traditional HF therapies in patients with HF from cardiac amyloidosis is unclear. Objective: The aim of this study was to evaluate the safety and efficacy of traditional HF therapies in patients with cardiac amyloidosis and HF with reduced ejection fraction (HFrEF) or HF with mid-range ejection fraction (HFmrEF). Methods: We conducted a single-center retrospective study. Patients were included if they were diagnosed with cardiac amyloidosis and HFrEF or HFmrEF between January 2012 and 2022. The primary outcomes of interest were medication use patterns (for beta blockers (BB), angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), angiotensin receptor-neprilysin inhibitors (ARNI), and mineralocorticoid receptor antagonists (MRA)); potential medication side effects (symptomatic bradycardia, fatigue, hypotension, lightheadedness, and syncope); hospitalization; and death. The associations of BB, ACEI/ARB/ARNI, and MRA use with clinical outcomes were evaluated using Kaplan Meir and Cox proportional hazards regression. Results: 82 patients met study criteria. At time of cardiac amyloidosis diagnosis, 63.4% were on a BB, 51.2% were on an ACEI/ARB/ARNI, and 43.9% were on an MRA. At last follow up, 51.2% were on a BB, 35.4% were on an ACEI/ARB/ARNI, and 43.9% were on a MRA. There were no statistically significant differences in rates of potential medication side effects in patients on the medication class compared to those who were not. There was no association with mortality for baseline or follow-up BB, ACEI/ARB/ARNI, or MRA use. There was an association with hospitalization for baseline and follow-up MRA use, but this effect was lost after controlling for pre-specified covariates. Conclusions: BB, ACEI/ARB/ARNI, and MRA use is not infrequent in patients with concomitant cardiac amyloidosis and HFrEF or HFmrEF. These traditional HF therapies may be safely used in this population. However, their use does not appear to improve mortality or hospitalization.