接受专门息治疗的晚期癌症患者的心力衰竭治疗 (EMPATICC试验)
Markus S Anker1,2,3,4, Amir A Mahabadi5, Matthias Totzeck5
1Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany.
European heart journal
|August 30, 2025
概括
优化心力衰竭 (HF) 治疗没有改善晚期癌症患者的自我护理. 然而,在幸存者中,高频疗法在生活质量和心脏生物标志物方面显示出潜在的益处,因此需要进一步研究.
科学领域:
- 癌症学
- 心脏病学
- 缓和护理
背景情况:
- 晚期的癌症可能呈现出类似心力衰竭 (HF) 的表型,包括心脏衰竭和呼吸障碍.
- 晚期癌症患者经常出现身体功能障碍和自我护理能力下降.
- 专门的缓解治疗对于治疗晚期癌症患者的复杂症状至关重要.
研究的目的:
- 在接受息治疗的晚期癌症患者中评估优化心力衰竭治疗的安全性和有效性.
- 确定HF治疗是否可以改善晚期癌症患者的自我护理能力.
- 评估HF治疗对心血管生物标志物和生活质量的影响.
主要方法:
- 这是一项随机,双盲,安慰剂对照试验,涉及93名患有第四阶段固体瘤的患者,预期寿命为1-6个月.
- 参与者接受了优化的HF治疗 (萨库比特里尔/ 瓦尔萨坦,艾帕格利夫洛辛,伊瓦布拉丁,铁糖) 或安慰剂.
- 主要终点评估了30天内活着并能够进行个人卫生,移动性 (4米步行) 和患者整体评估 (PGA) 的自我护理能力.
主要成果:
- 在HF治疗和安慰剂组之间,提高自我护理能力的主要终点没有显著差异 (胜率为0. 95,P=0. 83).
- 整体30天死亡率为32%,并且在不同组之间没有差异.
- 在30天的幸存者中,HF治疗显著降低了N端的B型亲尿酸水平 (P=0. 040),增加了左心室射出分数 (P=0. 036) 和改善了PGA分数 (P=0. 016).
结论:
- 在接受息治疗的晚期癌症患者中,优化心力衰竭 (HF) 治疗没有提高自我护理能力,这可能是由于早期死亡率高.
- 在30天的幸存者中,个性化HF治疗在生活质量和心脏生物标志物方面表现出潜在的好处.
- 这些发现产生了假设,并表明需要对晚期癌症患者量身定制的HF干预进行进一步的验证研究.
相关概念视频
01:22Heart Failure VI: Adjunct Therapies
27
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
27
01:30Heart Failure VII: Nursing Interventions
139
The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
139
01:30Heart Failure V: Medical Management
23
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
23
01:30Cardiomyopathy II: Dilated Cardiomyopathy
21
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
21
01:30Heart Failure IV: Classification and Diagnostic Evaluation
32
Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
32
01:29Cardiomyopathy V: Interprofessional Care
32
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
32