Randomized investigation of heart failure therapy in patients with advanced cancer at risk of cardiac wasting: Rationale and design of the EMPATICC trial
Article Swipe
Markus S. Anker
,
Amir A. Mahabadi
,
Matthias Totzeck
,
Mitra Tewes
,
Raluca Mincu
,
Muhammad Shahzeb Khan
,
Javed Butler
,
Ulrich Keller
,
Johann Ahn
,
Lars Bullinger
,
Dominik Paul Modest
,
Ulf Landmesser
,
Lorenz Lehmann
,
Sven Bercker
,
Ulrich Laufs
,
Michael Böhm
,
Bela Merkely
,
Monika Diek
,
Tim Heise
,
Martin Hellmich
,
Marius Placzek
,
Tim Friede
,
Stefan D. Anker
,
Tienush Rassaf
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1002/ejhf.3799
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1002/ejhf.3799
Aims End‐stage cancer may resemble a heart failure (HF)‐like phenotype marked by cardiac wasting, dysfunction, and symptoms such as dyspnoea, congestion, and impaired physical function. The EMPATICC (EMPower the heArt of patients with TermInal Cancer using Cardiac medicines) trial evaluates the safety and efficacy of optimized HF therapy in patients with advanced cancer to improve self‐care ability. Methods EMPATICC is a multicentre, investigator‐initiated, randomized, double‐blind, controlled, proof‐of‐concept trial employing a joint cardio‐oncology care approach. Patients were randomized 1:1 to optimized HF therapy (sacubitril/valsartan, empagliflozin, ivabradine, ferric carboxymaltose) plus usual care, or usual care alone, for 30 days, followed by a 30‐day open‐label extension. Eligible patients had stage IV solid tumours (per Union for International Cancer Control), were receiving palliative care, had a 1–6 month life expectancy, and were on optimized analgesia. At baseline, first patients had to meet ≥2 criteria of the following indicating cardiovascular risk: heart rate ≥70 bpm, N‐terminal pro‐B‐type natriuretic peptide ≥600 pg/ml, elevated high‐sensitivity troponin, left ventricular ejection fraction <55%, left ventricular mass loss >15%, transferrin saturation <20%, or moderate/high likelihood of HF with preserved ejection fraction (based on the HFA‐PEFF score); and they had to meet at least one criterion of the following indicating functional limitation: ≥6 s to walk 4 m, inability to wash ≥3 days of the last 7 days, or symptoms of dyspnoea at rest. Enrolment ended 30 January 2025; 93 patients completed randomization. The primary endpoint is a hierarchical composite (analysed by win ratio): (1) days alive and able to wash, (2) 4 m walking ability, and (3) patient global assessment of well‐being. Conclusions EMPATICC evaluates whether HF therapy can improve function and well‐being in advanced cancer, potentially reshaping care in this population.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1002/ejhf.3799
- https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ejhf.3799
- OA Status
- hybrid
- Cited By
- 2
- References
- 43
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4413682459
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4413682459Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1002/ejhf.3799Digital Object Identifier
- Title
-
Randomized investigation of heart failure therapy in patients with advanced cancer at risk of cardiac wasting: Rationale and design of the
EMPATICC trialWork title - Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2025Year of publication
- Publication date
-
2025-08-26Full publication date if available
- Authors
-
Markus S. Anker, Amir A. Mahabadi, Matthias Totzeck, Mitra Tewes, Raluca Mincu, Muhammad Shahzeb Khan, Javed Butler, Ulrich Keller, Johann Ahn, Lars Bullinger, Dominik Paul Modest, Ulf Landmesser, Lorenz Lehmann, Sven Bercker, Ulrich Laufs, Michael Böhm, Bela Merkely, Monika Diek, Tim Heise, Martin Hellmich, Marius Placzek, Tim Friede, Stefan D. Anker, Tienush RassafList of authors in order
- Landing page
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https://doi.org/10.1002/ejhf.3799Publisher landing page
- PDF URL
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https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ejhf.3799Direct link to full text PDF
- Open access
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YesWhether a free full text is available
- OA status
-
hybridOpen access status per OpenAlex
- OA URL
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https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ejhf.3799Direct OA link when available
- Concepts
-
Medicine, Heart failure, Ejection fraction, Wasting, Randomized controlled trial, Internal medicine, Valsartan, Palliative care, Randomization, Cardiology, Sacubitril, Blood pressure, NursingTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
2Total citation count in OpenAlex
- Citations by year (recent)
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2025: 2Per-year citation counts (last 5 years)
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43Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.month | 124 |
| abstract_inverted_index.rest. | 223 |
| abstract_inverted_index.risk: | 146 |
| abstract_inverted_index.solid | 109 |
| abstract_inverted_index.stage | 107 |
| abstract_inverted_index.trial | 39, 68 |
| abstract_inverted_index.using | 36 |
| abstract_inverted_index.usual | 89, 92 |
| abstract_inverted_index.wash, | 250 |
| abstract_inverted_index.≥70 | 149 |
| abstract_inverted_index.(based | 182 |
| abstract_inverted_index.Cancer | 35, 115 |
| abstract_inverted_index.alone, | 94 |
| abstract_inverted_index.cancer | 3, 53 |
| abstract_inverted_index.ferric | 86 |
| abstract_inverted_index.global | 259 |
| abstract_inverted_index.marked | 11 |
| abstract_inverted_index.pg/ml, | 156 |
| abstract_inverted_index.safety | 42 |
| abstract_inverted_index.≥600 | 155 |
| abstract_inverted_index.Cardiac | 37 |
| abstract_inverted_index.January | 227 |
| abstract_inverted_index.Methods | 58 |
| abstract_inverted_index.cancer, | 276 |
| abstract_inverted_index.cardiac | 13 |
| abstract_inverted_index.failure | 8 |
| abstract_inverted_index.improve | 55, 270 |
| abstract_inverted_index.patient | 258 |
| abstract_inverted_index.peptide | 154 |
| abstract_inverted_index.primary | 234 |
| abstract_inverted_index.ratio): | 243 |
| abstract_inverted_index.score); | 186 |
| abstract_inverted_index.therapy | 48, 82, 268 |
| abstract_inverted_index.tumours | 110 |
| abstract_inverted_index.walking | 254 |
| abstract_inverted_index.whether | 266 |
| abstract_inverted_index.>15%, | 169 |
| abstract_inverted_index.<20%, | 172 |
| abstract_inverted_index.<55%, | 164 |
| abstract_inverted_index.(EMPower | 28 |
| abstract_inverted_index.30‐day | 101 |
| abstract_inverted_index.ABSTRACT | 0 |
| abstract_inverted_index.EMPATICC | 27, 59, 264 |
| abstract_inverted_index.Eligible | 104 |
| abstract_inverted_index.Patients | 75 |
| abstract_inverted_index.TermInal | 34 |
| abstract_inverted_index.ability, | 255 |
| abstract_inverted_index.ability. | 57 |
| abstract_inverted_index.advanced | 52, 275 |
| abstract_inverted_index.criteria | 140 |
| abstract_inverted_index.dyspnoea | 221 |
| abstract_inverted_index.efficacy | 44 |
| abstract_inverted_index.ejection | 162, 180 |
| abstract_inverted_index.elevated | 157 |
| abstract_inverted_index.endpoint | 235 |
| abstract_inverted_index.followed | 98 |
| abstract_inverted_index.fraction | 163, 181 |
| abstract_inverted_index.function | 271 |
| abstract_inverted_index.impaired | 23 |
| abstract_inverted_index.patients | 32, 50, 105, 135, 230 |
| abstract_inverted_index.physical | 24 |
| abstract_inverted_index.resemble | 5 |
| abstract_inverted_index.symptoms | 17, 219 |
| abstract_inverted_index.wasting, | 14 |
| abstract_inverted_index.(analysed | 240 |
| abstract_inverted_index.Control), | 116 |
| abstract_inverted_index.Enrolment | 224 |
| abstract_inverted_index.approach. | 74 |
| abstract_inverted_index.baseline, | 133 |
| abstract_inverted_index.completed | 231 |
| abstract_inverted_index.composite | 239 |
| abstract_inverted_index.criterion | 195 |
| abstract_inverted_index.dyspnoea, | 20 |
| abstract_inverted_index.employing | 69 |
| abstract_inverted_index.evaluates | 40, 265 |
| abstract_inverted_index.following | 143, 198 |
| abstract_inverted_index.function. | 25 |
| abstract_inverted_index.inability | 208 |
| abstract_inverted_index.optimized | 46, 80, 130 |
| abstract_inverted_index.phenotype | 10 |
| abstract_inverted_index.preserved | 179 |
| abstract_inverted_index.receiving | 118 |
| abstract_inverted_index.reshaping | 278 |
| abstract_inverted_index.troponin, | 159 |
| abstract_inverted_index.HFA‐PEFF | 185 |
| abstract_inverted_index.analgesia. | 131 |
| abstract_inverted_index.assessment | 260 |
| abstract_inverted_index.extension. | 103 |
| abstract_inverted_index.functional | 200 |
| abstract_inverted_index.indicating | 144, 199 |
| abstract_inverted_index.likelihood | 175 |
| abstract_inverted_index.medicines) | 38 |
| abstract_inverted_index.palliative | 119 |
| abstract_inverted_index.randomized | 77 |
| abstract_inverted_index.saturation | 171 |
| abstract_inverted_index.(HF)‐like | 9 |
| abstract_inverted_index.Conclusions | 263 |
| abstract_inverted_index.End‐stage | 2 |
| abstract_inverted_index.congestion, | 21 |
| abstract_inverted_index.controlled, | 66 |
| abstract_inverted_index.expectancy, | 126 |
| abstract_inverted_index.ivabradine, | 85 |
| abstract_inverted_index.limitation: | 201 |
| abstract_inverted_index.natriuretic | 153 |
| abstract_inverted_index.population. | 282 |
| abstract_inverted_index.potentially | 277 |
| abstract_inverted_index.randomized, | 64 |
| abstract_inverted_index.self‐care | 56 |
| abstract_inverted_index.transferrin | 170 |
| abstract_inverted_index.ventricular | 161, 166 |
| abstract_inverted_index.N‐terminal | 151 |
| abstract_inverted_index.dysfunction, | 15 |
| abstract_inverted_index.hierarchical | 238 |
| abstract_inverted_index.multicentre, | 62 |
| abstract_inverted_index.open‐label | 102 |
| abstract_inverted_index.well‐being | 273 |
| abstract_inverted_index.International | 114 |
| abstract_inverted_index.moderate/high | 174 |
| abstract_inverted_index.well‐being. | 262 |
| abstract_inverted_index.cardiovascular | 145 |
| abstract_inverted_index.empagliflozin, | 84 |
| abstract_inverted_index.pro‐B‐type | 152 |
| abstract_inverted_index.randomization. | 232 |
| abstract_inverted_index.carboxymaltose) | 87 |
| abstract_inverted_index.double‐blind, | 65 |
| abstract_inverted_index.cardio‐oncology | 72 |
| abstract_inverted_index.high‐sensitivity | 158 |
| abstract_inverted_index.proof‐of‐concept | 67 |
| abstract_inverted_index.(sacubitril/valsartan, | 83 |
| abstract_inverted_index.investigator‐initiated, | 63 |
| cited_by_percentile_year.max | 97 |
| cited_by_percentile_year.min | 95 |
| corresponding_author_ids | https://openalex.org/A5061494282, https://openalex.org/A5002162665 |
| countries_distinct_count | 4 |
| institutions_distinct_count | 24 |
| corresponding_institution_ids | https://openalex.org/I39343248, https://openalex.org/I4210127591, https://openalex.org/I4210148371, https://openalex.org/I4210161917, https://openalex.org/I62318514, https://openalex.org/I7877124, https://openalex.org/I7882870 |
| citation_normalized_percentile.value | 0.9606603 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | True |