Impact and safety of using concomitant HF treatments with available ATTR-CM treatments

Abstract Transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized cause of heart failure. Evidence regarding the use of conventional neurohormonal therapies in ATTR-CM has historically been controversial, largely because earlier studies were conducted in patients with advanced disease stages who were often unable to tolerate these treatments. However, more recent data have suggested a potential role for selected heart failure therapies in ATTR-CM. Current recommendations from the Heart Failure Association of the European Society of Cardiology and the American College of Cardiology endorse the routine use of mineralocorticoid receptor antagonists and sodium-glucose cotransporter-2 inhibitors across the spectrum of left ventricular ejection fraction (LVEF) to reduce all-cause mortality. Beta-blockers may be considered at low doses in patients with a LVEF ≤ 40%, whereas angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are not routinely recommended. Randomized controlled trials (RCTs) are needed to assess the impact of conventional heart failure therapies in ATTR-CM.