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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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
30 August 2025
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| In: |
European heart journal
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| ISSN: | 1522-9645 |
| DOI: | 10.1093/eurheartj/ehaf705 |
| Online Access: | 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 
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| Author Notes: | 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 |
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| 245 | 1 | 0 | |a Heart failure therapy in patients with advanced cancer receiving specialized palliative care (EMPATICC trial) |c 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 |
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| 520 | |a 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. | ||
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