Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：据推测，癌症阻碍了针对心力衰竭（HF）的指南指导药物治疗（GDMT）的实施。然而,这方面的数据很少。
方法：我们对热诺瓦的IRCCSOspedalePoliclinicoSanMartino的HF门诊进行了回顾性分析，意大利。在2010年至2019年期间评估的所有HF患者，左心室射血分数<50％，并且至少两次间隔≥3个月的访问以及有关GDMT的完整信息被纳入研究。我们特别评估了GDMT的处方，β受体阻滞剂（BB），肾素-血管紧张素系统抑制剂（RASi），和盐皮质激素拮抗剂（MRA）-在最后一次HF评估时，并在有和无偶发癌症的患者之间进行比较。对于那些患有癌症的人来说，我们还评估了GDMT的修改,比较了癌症诊断前后的HF评估结果.
结果：在464例HF患者中，39例(8%)有偶发癌。在最后一次评估中，有和没有偶然癌症的患者之间的GDMT没有统计学差异。在癌症诊断后的一年，在BB上的33例偶然癌症患者中，没有人停止治疗，但是有两个人的剂量低于50%；在RASi的27名患者中，两名患者停止了治疗，三名患者的剂量下降至<50％；在MRA的19名患者中，四个停止治疗。
结论：尽管患有偶发癌症的HF患者在诊断癌症时可能需要进行GDMT的滴定，这似乎并未显著阻碍随访期间HF治疗的实施.
方法：我们对热诺瓦的IRCCSOspedalePoliclinicoSanMartino的HF门诊进行了回顾性分析，意大利。在2010年至2019年期间评估的所有HF患者，左心室射血分数<50％，并且至少两次间隔≥3个月的访问以及有关GDMT的完整信息被纳入研究。我们特别评估了GDMT的处方，β受体阻滞剂（BB），肾素-血管紧张素系统抑制剂（RASi），和盐皮质激素拮抗剂（MRA）-在最后一次HF评估时，并在有和无偶发癌症的患者之间进行比较。对于那些患有癌症的人来说，我们还评估了GDMT的修改,比较了癌症诊断前后的HF评估结果.
结果：在464例HF患者中，39例(8%)有偶发癌。在最后一次评估中，有和没有偶然癌症的患者之间的GDMT没有统计学差异。在癌症诊断后的一年，在BB上的33例偶然癌症患者中，没有人停止治疗，但是有两个人的剂量低于50%；在RASi的27名患者中，两名患者停止了治疗，三名患者的剂量下降至<50％；在MRA的19名患者中，四个停止治疗。
结论：尽管患有偶发癌症的HF患者在诊断癌症时可能需要进行GDMT的滴定，这似乎并未显著阻碍随访期间HF治疗的实施.
