Combination of Drug Treatment, Valve Replacement Improves Survival for Patients With Complex Heart Disease

Aortic stenosis and cardiac amyloidosis, with transthyretin-associated cardiac amyloidosis (ATTR-CA) being the most common form, frequently occur in combination, causing structural heart failure in older adults. In an international study, researchers have discovered that a combination of aortic valve replacement (AVR) and drug treatment for amyloidosis can considerably prolong the life of these older adult patients.

The large-scale study was published in the European Heart Journal and comprised data from 226 patients in 16 heart centers in 10 countries. The patients were all diagnosed with aortic stenosis and cardiac amyloidosis. A large number of patients have only been treated for aortic stenosis, and ATTR-CA is not treated in many cases because of the lack of research and availability of specific drugs.

The team of researchers, headed by Dr. Christian Nitsche of Medical University of  Vienna and Dr. Thomas Treibel of University College London, found that the patients who received both interventions, AVR and ATTR-specific drug treatment, had a significantly higher survival probability in comparison with patients who received only one or no intervention at all. The survival of those who underwent both interventions was almost equal to that of patients with aortic stenosis but without ATTR-CA.

Another issue mentioned in the study was limited access to amyloidosis drugs, mainly because of lack of reimbursement or availability in certain areas. Despite this, utilization of the drug has been on the rise over the years—from 0% before 2017 to more than 50% in the past 3 years. The most widespread drug used in the study, tafamidis, treats amyloidosis by stabilizing the protein that causes this condition and inhibiting formation of harmful deposits in the heart.

Of the 226 patients involved in the research, approximately 30% were receiving tafamidis. These patients were younger and healthier on the whole; however, they had more serious signs of amyloidosis. They also experienced improved heart functioning and reduced complications as compared with those who did not receive the drug.

The authors employed modern statistical models to compare patient outcomes and discovered that patients who received both the drug and AVR survived much longer.

The study presents the first evidence that both the aortic stenosis and ATTR-CA can be managed with significant increase in survival, thus making the outcomes more comparable to those of patients without amyloidosis.