Beta-Adrenergic Antagonist Tolerance in Amyloid Cardiomyopathy

Figures

• 

  Figure 1. Schematic to identify cardiac amyloidosis patients. Identification of cardiac amyloidosis patients based on ICD codes: Criterion 1, Diagnosis with wild type Wild-Type Transthyretin Amyloidosis (wtATTR), Light Chain Amyloidosis (AL) or Hereditary Transthyretin Amyloidosis (hATTR), with known cardiac involvement. OR Criterion 2, Diagnosis of heart failure (ICD-9: 428.* ; ICD-10: I50.*) plus diagnosis of amyloidosis (ICD-9: 277.3* ; ICD-10 E85.*). AA, Secondary Amyloidosis; PYP scan, Technetium-99 Pyrophosphate Scintigraphy.

• 

  Figure 2. Beta-blocker indications. Indication for beta-blocker use among patients receiving current and prior beta-blocker therapy. The current group includes cardiac amyloid patients who were on beta-blocker therapy at time of data collection. The prior group includes cardiac amyloid patients who were previously on beta-blocker therapy but were no longer using beta-blockers at the time of data collection. The most common reason for beta-blocker therapy in both groups included heart failure followed by hypertension. CAD, Coronary Artery Disease, HF, Heart Failure; HTN, Hypertension.

• 

  Figure 3. Reasons for beta-blocker discontinuation. Listed are the reasons for discontinuation of behhta-blocker therapy among cardiac amyloid patients. The most common reasons for stopping beta-blocker therapy were hypotension, bradycardia, fatigue, and orthostasis.

• 

  Figure 4. Summary Figure. Beta-blocker use and tolerance were analyzed in a cohort of patients with confirmed amyloid cardiomyopathy in a large amyloidosis referral center in the United States. The most common indications for beta blocker (BB) therapy in our cohort included heart failure, hypertension, arrhythmia, and coronary artery disease. Most patients in our study cohort were prescribed a beta blocker (BB). Of these, over half of them were tolerating the therapy enough to remain on the medication. Between patient groups tolerating (Current BB Use) and not tolerating (Prior BB Use) BB therapy, no significant differences in cardiac profiles, neurologic symptom incidence, amyloid type, or demographic data exist. The most common reasons for BB discontinuation include hypotension, bradycardia, fatigue, and orthostasis.