Risk-guided disease management to prevent heart failure in adult cancer survivors of previous cardiotoxic cancer treatments: Baseline results of the REDEEM trial.

BACKGROUND

Adult cancer survivors are at increased risk of heart failure (HF) due to standard risk factors and cancer treatment-related cardiac dysfunction. However, the prevalence and treatment of subclinical/stage B heart failure (SBHF) in this population are not well defined.

OBJECTIVES

The REDEEM (Risk-guided Disease managEment plan to prevEnt heart failure in patients treated with previous cardiotoxic cancer treatMents) trial will evaluate HF screening and targeted intervention in long-term cancer survivors.

METHODS

Survivors ≥40 years old, ≥5 years post potentially-cardiotoxic therapy, and with ≥1 HF risk factor were screened by echocardiography for SBHF (abnormal global longitudinal shortening [GLS], left ventricular hypertrophy [LVH], diastolic dysfunction or abnormal 3-dimensional left ventricular ejection fraction [3D-LVEF]). Those with SBHF were randomized to multidisciplinary cardio-oncology disease management plan (CO-DMP), including neurohormonal blockade, exercise training and risk factor optimization, or usual care. The primary endpoint is change in cardiorespiratory fitness (VO2peak) over 6 months.

RESULTS

Of 1,124 survivors screened, 604 underwent echocardiography, and 145 (24%) had SBHF (age 68±18 years; 81% women). Of those eligible for randomization, 64% had breast cancer and 35% had hematological malignancy. Although baseline 3D-LVEF was preserved (52.8 ± 6.8%), subclinical LV dysfunction was common (GLS 15.6 ± 2.1%) and 39% had evidence of functional impairment (VO2peak≤18ml/kg/min-1). Abnormal GLS was associated with age, BMI, diabetes and anthracycline exposure, whereas functional impairment was only associated with age. Abnormal GLS and functional impairment were not significantly associated (OR 0.90 [95% CI 0.72-1.11], P = .360).

CONCLUSIONS

Risk-based screening can identify a high-risk subpopulation of cancer survivors with SBHF.

REGISTRATION: ClinicalTrials.gov NCT04962711, https://www.

CLINICALTRIALS: gov/study/NCT04962711.