Evidence mapPaperPMID 40857084Full record

ArticleEuropean journal of heart failure2025

Randomized investigation of heart failure therapy in patients with advanced cancer at risk of cardiac wasting: Rationale and design of the EMPATICC trial.

Markus S Anker, Amir A Mahabadi, Matthias Totzeck, Mitra Tewes, Raluca Mincu, Muhammad Shahzeb Khan, Javed Butler, Ulrich Keller, Johann Ahn, Lars Bullinger and 14 more

Abstract readClinical Trial Protocol
In one paragraph

Article in European journal of heart failure, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Trial
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors.

Markus S AnkerCharité-University Medicine Berlin Corporate Member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany.ORCID https://orcid.org/0000-0002-4406-8555
Amir A MahabadiWest German Heart and Vascular Center, Clinic of Cardiology and Vascular Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Matthias TotzeckWest German Heart and Vascular Center, Clinic of Cardiology and Vascular Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Mitra TewesDepartment of Palliative Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Raluca MincuWest German Heart and Vascular Center, Clinic of Cardiology and Vascular Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Muhammad Shahzeb KhanBaylor Scott and White Research Institute, Dallas, TX, USA.
Javed ButlerBaylor Scott and White Research Institute, Dallas, TX, USA.
Ulrich KellerDepartment of Hematology, Oncology and Cancer Immunology, Charité-University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany.
Johann AhnDepartment of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Lars BullingerDepartment of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Dominik P ModestDepartment of Hematology, Oncology and Cancer Immunology, Charité-University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany.
Ulf LandmesserCharité-University Medicine Berlin Corporate Member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany.
Lorenz H LehmannDepartment of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany.
Sven BerckerDepartment of Anesthesiology and Critical Care Medicine, University Hospital Leipzig, Leipzig, Germany.
Ulrich LaufsKlinik und Poliklinik für Kardiologie Universitätsklinikum Leipzig, Leipzig, Germany.
Michael BöhmKlinik für Innere Medizin III and HOMICAREM - Homburg Institute for Cardio Renal Metabolic Medicine, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany.
Bela MerkelyHeart and Vascular Centre, Semmelweis University, Budapest, Hungary.
Monika DiekCharité-University Medicine Berlin Corporate Member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany.
Tim HeiseProfil, Neuss, Germany.
Martin HellmichDepartment of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.
Marius PlaczekDepartment of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.
Tim FriedeDepartment of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.ORCID https://orcid.org/0000-0001-5347-7441
Stefan D AnkerDepartment of Cardiology (CVK), German Centre for Cardiovascular Research Partner Site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.
Tienush RassafWest German Heart and Vascular Center, Clinic of Cardiology and Vascular Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsEnd-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.

methodsEMPATICC 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.

conclusionsEMPATICC evaluates whether HF therapy can improve function and well-being in advanced cancer, potentially reshaping care in this population.

Indexed as

Heart FailureNeoplasmsAgedAminobutyratesAngiotensin Receptor AntagonistsBenzhydryl CompoundsBiphenyl CompoundsDouble-Blind MethodDrug CombinationsFemaleFerric CompoundsGlucosidesHumansIvabradineMaleMaltoseAminobutyratesAngiotensin Receptor AntagonistsBenzhydryl CompoundsBiphenyl CompoundsDrug Combinationsempagliflozinferric carboxymaltoseFerric CompoundsGlucosidesIvabradineMaltosesacubitril and valsartan sodium hydrate drug combinationValsartanCardiac wastingClinical trialEnd‐stage cancerHeart failure therapy

Identifiers

PMID40857084
PMCPMC12575421

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.