Beta-Blocker Exposure and Survival in Patients With Transthyretin Amyloid Cardiomyopathy |
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| Affiliation: | 1. Complejo Hospitalario Universitario de A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña (UDC), A Coruña, Spain;2. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain;3. Complejo Hospitalario Universitario de Ferrol (CHUF), SERGAS, Ferrol (A Coruña), Spain;4. Complejo Hospitalario Universitario de Vigo (CHUVI), SERGAS, Vigo (Pontevedra), Spain;5. Complejo Hospitalario Universitario de Pontevedra (CHOP), SERGAS, Pontevedra, Spain;6. Complejo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Santiago de Compostela (A Coruña), Spain;7. Hospital Lucus Augusti (HULA), SERGAS, Lugo, Spain;8. Complejo Hospitalario Universitario de Ourense (CHUOU), SERGAS, Ourense, Spain;1. University of Texas Southwestern Medical School, Dallas, TX;2. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX;3. Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD;4. Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD;5. Department of Kinesiology, Faculty of Medicine, Université Laval and VITAM – Centre de rercherche en santé durable, CIUSSS Capitale-Nationale, Québec, QC, Canada;6. AMRA Medical AB, Linköping, Sweden;7. Division of Society and Health, Linköping University, Linköping, Sweden;8. Division of Diagnostics and Specialist Medicine, Linköping University, Linköping, Sweden;9. Department of Health, Medicine, and Caring Sciences, Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden;10. Division of Biomedical Engineering, Department of Biomedical Engineering, Linköping University, Linköping, Sweden;11. University Hospitals Harrington Heart and Vascular Institute and Case Western Reserve University School of Medicine, Cleveland, OH;1. Department of Dermatology;2. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN;1. Department of Internal Medicine, Mayo Clinic, Rochester, MN;2. Department of Health Sciences Research, Mayo Clinic, Rochester, MN;3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN;4. Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN;5. Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN;6. Department of Internal Medicine, School of Medicine, Kangwon National University, Republic of Korea;1. Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN;2. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN;3. Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN;4. Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN;5. Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN;6. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT;7. Flying Buttress Associates, Charlottesville, VA;8. Division of Rheumatology, Department of Medicine, Medical College of Wisconsin, Milwaukee;9. Section of General Internal Medicine and the National Clinician Scholars Program, Department of Medicine, Yale School of Medicine Department of Health Policy and Management, Yale School of Public Health and Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, CT |
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| Abstract: | ObjectiveTo investigate a potential association between beta-blocker exposure and survival in patients with transthyretin amyloid cardiomyopathy (ATTR-CM).MethodsIn this real-world prospective registry of 128 consecutive patients with ATTR-CM recruited in 7 institutions in Galicia (Spain), survival of 65 patients who received beta blockers on registry enrollment was compared with that of 63 untreated controls by means of both unweighted Cox regression and Cox regression with inverse probability of treatment weighting. Tolerance to and adverse effects of beta blockers were recorded. Median study follow-up was 520 days.ResultsPatients with ATTR-CM who received beta blockers showed statistically significant lower all-cause mortality than untreated controls as evaluated by either unweighted Cox regression (hazard ratio, 0.31; 95% CI, 0.12 to 0.79) or Cox regression with inverse probability of treatment weighting (hazard ratio, 0.18; 95% CI, 0.08 to 0.41; P<.001). Several sensitivity analyses confirmed the internal validity of these results. The overall frequency of beta-blocker suspension due to adverse effects was 25% (95% CI, 15.5% to 34.5%).ConclusionIn this real-world, prospective, multi-institutional registry, patients with ATTR-CM who received beta blockers had lower all-cause mortality than untreated controls. |
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