Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy.
Department of Internal Medicine, University of Genova, Genova, Italy.
Heart Lung Circ. 2024 May;33(5):704-709. doi: 10.1016/j.hlc.2024.03.008. Epub 2024 Apr 11.
It has been postulated that cancer hampers the delivery of guideline-directed medical therapy (GDMT) for heart failure (HF). However, few data are available in this regard.
We performed a retrospective analysis from the HF Outpatient Clinic of the IRCCS Ospedale Policlinico San Martino in Genova, Italy. All HF patients evaluated between 2010 and 2019, with a left ventricular ejection fraction <50% and at least two visits ≥3 months apart with complete information about GDMT were included in the study. We assessed the prescription of GDMT-in particular, beta-blockers (BB), renin-angiotensin system inhibitors (RASi), and mineralocorticoid antagonists (MRA)-at the time of the last HF evaluation and compared it between patients with and without incidental cancer. For those with incidental cancer, we also evaluated modifications of GDMT comparing the HF evaluations before and after cancer diagnosis.
Of 464 HF patients, 39 (8%) had incidental cancer. There were no statistical differences in GDMT between patients with and without incidental cancer at last evaluation. In the year following cancer diagnosis, of 33 patients with incidental cancer on BB, none stopped therapy, but two had a down-titration to a dosage <50%; of 27 patients on RASi, two patients stopped therapy and three had a down-titration to a dosage <50%; of 19 patients on MRA, four stopped therapy.
Although HF patients with incidental cancer may need to have GDMT down-titrated at the time of cancer diagnosis, this does not appear to significantly hinder the delivery of HF therapies during follow-up.
据推测，癌症会妨碍心力衰竭（HF）患者接受指南指导的医学治疗（GDMT）。然而，这方面的数据很少。
我们对意大利热那亚圣马蒂诺IRCCS 医院 HF 门诊进行了回顾性分析。所有在 2010 年至 2019 年期间接受评估、左心室射血分数<50%且至少有两次间隔≥3 个月的 HF 患者均包含在研究中，且每次就诊均有 GDMT 完整信息。我们评估了 GDMT 的使用情况，特别是β受体阻滞剂（BB）、肾素-血管紧张素系统抑制剂（RASi）和盐皮质激素受体拮抗剂（MRA），并在最后一次 HF 评估时比较了有和无偶然癌症的患者之间的 GDMT 情况。对于偶然患有癌症的患者，我们还比较了癌症诊断前后 HF 评估时 GDMT 的变化。
在 464 例 HF 患者中，39 例（8%）患有偶然癌症。在最后一次评估时，有和无偶然癌症的患者之间的 GDMT 无统计学差异。在癌症诊断后的一年中，33 例接受 BB 治疗的偶然癌症患者中，没有患者停止治疗，但有 2 例患者的剂量下调至<50%；27 例接受 RASi 治疗的患者中，有 2 例患者停止治疗，有 3 例患者的剂量下调至<50%；19 例接受 MRA 治疗的患者中，有 4 例患者停止治疗。
尽管偶然患有癌症的 HF 患者在诊断时可能需要下调 GDMT，但这似乎并没有显著阻碍 HF 治疗在随访期间的实施。
