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Heart failure therapy in patients with advanced cancer receiving specialized palliative care (EMPATICC trial)

Advanced cancer may resemble a heart failure (HF)-like phenotype marked by cardiac wasting, dyspnoea, congestion, and/or physical dysfunction. The trial evaluated safety and efficacy of HF therapy among patients with advanced cancer receiving specialized palliative care to improve patients’ self-car...

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Hauptverfasser: Anker, Markus (VerfasserIn) , Mahabadi, Amir A (VerfasserIn) , Totzeck, Matthias (VerfasserIn) , Tewes, Mitra (VerfasserIn) , Khan, Muhammad Shahzeb (VerfasserIn) , Mincu, Raluca I (VerfasserIn) , Hendgen-Cotta, Ulrike B (VerfasserIn) , Michel, Lars (VerfasserIn) , Mathew, Baicy (VerfasserIn) , Drescher, Ophelia (VerfasserIn) , Schuler, Martin (VerfasserIn) , Keller, Ulrich (VerfasserIn) , Rieger, Kathrin (VerfasserIn) , Ahn, Johann (VerfasserIn) , Bullinger, Lars (VerfasserIn) , Modest, Dominik P (VerfasserIn) , Denecke, Corinna (VerfasserIn) , Kretzler, Lucie (VerfasserIn) , Ramer, Luisa V (VerfasserIn) , Krug, Danara (VerfasserIn) , Landmesser, Ulf (VerfasserIn) , Lehmann, Lorenz (VerfasserIn) , Frey, Norbert (VerfasserIn) , Bercker, Sven (VerfasserIn) , Laufs, Ulrich (VerfasserIn) , Böhm, Michael (VerfasserIn) , Mahfoud, Felix (VerfasserIn) , Merkely, Bela (VerfasserIn) , Diek, Monika (VerfasserIn) , Butler, Javed (VerfasserIn) , Veiser, Anja (VerfasserIn) , Heise, Tim (VerfasserIn) , Hellmich, Martin (VerfasserIn) , Placzek, Marius (VerfasserIn) , Friede, Tim (VerfasserIn) , Anker, Stefan D (VerfasserIn) , Rassaf, Tienush (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: 30 August 2025
In: European heart journal

ISSN:1522-9645
DOI:10.1093/eurheartj/ehaf705
Online-Zugang:Verlag, kostenfrei, Volltext: https://doi.org/10.1093/eurheartj/ehaf705
Verlag, kostenfrei, Volltext: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaf705/8242490?login=true
Volltext
Verfasserangaben:Markus S Anker, Amir A Mahabadi, Matthias Totzeck, Mitra Tewes, Muhammad Shahzeb Khan, Raluca I Mincu, Ulrike B Hendgen-Cotta, Lars Michel, Baicy Mathew, Ophelia Drescher, Martin Schuler, Ulrich Keller, Kathrin Rieger, Johann Ahn, Lars Bullinger, Dominik P Modest, Corinna Denecke, Lucie Kretzler, Luisa V Ramer, Danara Krug, Ulf Landmesser, Lorenz H Lehmann, Norbert Frey, Sven Bercker, Ulrich Laufs, Michael Böhm, Felix Mahfoud, Bela Merkely, Monika Diek, Javed Butler, Anja Veiser, Tim Heise, Martin Hellmich, Marius Placzek, Tim Friede, Stefan D Anker, and Tienush Rassaf
Beschreibung
Zusammenfassung:Advanced cancer may resemble a heart failure (HF)-like phenotype marked by cardiac wasting, dyspnoea, congestion, and/or physical dysfunction. The trial evaluated safety and efficacy of HF therapy among patients with advanced cancer receiving specialized palliative care to improve patients’ self-care ability.Patients with stage 4 solid tumours with a life expectancy of 1-6 months receiving specialized palliative care were enrolled. Patients were required to meet at least two cardiovascular risk criteria and at least one criterion for functional limitation. Participants were randomized 1:1 to receive optimized HF therapy (up to four drugs: sacubitril/valsartan, empagliflozin, ivabradine, ferric carboxymaltose) or placebo in a double-blind setting. The primary hierarchical endpoint included: (i) days alive and able to wash oneself, (ii) ability to walk 4 m, and (iii) self-reported patient global assessment (PGA) of subjective well-being, during the 30-day placebo-controlled phase.In five centres, 93 patients were randomized. The primary endpoint did not differ between groups (win ratio 0.95, 95% confidence interval [CI] 0.57-1.58; P = .83). Overall, mortality was 32% at 30 days (not different between groups). In patients alive at 30 days, HF therapy reduced N-terminal pro-B-type natriuretic peptide levels by 41% (P = .040), increased left ventricular ejection fraction by 2.9% (P = .036), and improved PGA scores (odds ratio 0.22, 95% CI 0.06-0.75; P = .016).In a population with advanced cancer receiving specialized palliative care and high early mortality, optimized HF therapy did not improve patients’ self-care ability. Among survivors at 30 days, improvements in quality of life measures and cardiac biomarkers suggest potential benefit of individualized HF therapy, which is hypothesis generating and needs validation.
Beschreibung:Gesehen am 20.01.2026
Beschreibung:Online Resource
ISSN:1522-9645
DOI:10.1093/eurheartj/ehaf705

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