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Impact of empagliflozin on decongestion in acute heart failure: the EMPULSE trial : clinical research : clinical trials

Effective and safe decongestion remains a major goal for optimal management of patients with acute heart failure (AHF). The effects of the sodium-glucose cotransporter 2 inhibitor empagliflozin on decongestion-related endpoints in the EMPULSE trial (NCT0415775) were evaluated.A total of 530 patients...

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Main Authors: Biegus, Jan (Author) , Voors, Adriaan A (Author) , Collins, Sean P (Author) , Kosiborod, Mikhail N (Author) , Teerlink, John R (Author) , Angermann, Christiane E (Author) , Tromp, Jasper (Author) , Ferreira, Joao Pedro (Author) , Nassif, Michael E (Author) , Psotka, Mitchell A (Author) , Brückmann, Martina (Author) , Salsali, Afshin (Author) , Blatchford, Jonathan P (Author) , Ponikowski, Piotr (Author)
Format: Article (Journal)
Language:English
Published: 1 January 2023
In: European heart journal
Year: 2023, Volume: 44, Issue: 1, Pages: 41-50a
ISSN:1522-9645
DOI:10.1093/eurheartj/ehac530
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1093/eurheartj/ehac530
Verlag, kostenfrei, Volltext: https://academic.oup.com/eurheartj/article/44/1/41/6762535?login=true
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Author Notes:Jan Biegus, Adriaan A. Voors, Sean P. Collins, Mikhail N. Kosiborod, John R. Teerlink, Christiane E. Angermann, Jasper Tromp, Joao Pedro Ferreira, Michael E. Nassif, Mitchell A. Psotka, Martina Brueckmann, Afshin Salsali, Jonathan P. Blatchford, and Piotr Ponikowski
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Summary:Effective and safe decongestion remains a major goal for optimal management of patients with acute heart failure (AHF). The effects of the sodium-glucose cotransporter 2 inhibitor empagliflozin on decongestion-related endpoints in the EMPULSE trial (NCT0415775) were evaluated.A total of 530 patients hospitalized for AHF were randomized 1:1 to either empagliflozin 10 mg once daily or placebo for 90 days. The outcomes investigated were: weight loss (WL), WL adjusted for mean daily loop diuretic dose (WL-adjusted), area under the curve of change from baseline in N-terminal pro-B-type natriuretic peptide levels, hemoconcentration, and clinical congestion score after 15, 30, and 90 days of treatment. Compared with placebo, patients treated with empagliflozin demonstrated significantly greater reductions in all studied markers of decongestion at all time-points, adjusted mean differences (95% confidence interval) at Days 15, 30, and 90 were: for WL −1.97 (−2.86, −1.08), −1.74 (−2.73, −0.74); −1.53 (−2.75, −0.31) kg; for WL-adjusted: −2.31 (−3.77, −0.85), −2.79 (−5.03, −0.54), −3.18 (−6.08, −0.28) kg/40 mg furosemide i.v. or equivalent; respectively (all P < 0.05). Greater WL at Day 15 (i.e. above the median WL in the entire population) was associated with significantly higher probability for clinical benefit at Day 90 (hierarchical composite of all-cause death, heart failure events, and a 5-point or greater difference in Kansas City Cardiomyopathy Questionnaire total symptom score change from baseline to 90 days) with the win ratio of 1.75 (95% confidence interval 1.37, 2.23; P < 0.0001).Initiation of empagliflozin in patients hospitalized for AHF resulted in an early, effective and sustained decongestion which was associated with clinical benefit at Day 90.
Item Description:Online vorab veröffentlicht: 18. Oktober 2022
Gesehen am 17.06.2024
Physical Description:Online Resource
ISSN:1522-9645
DOI:10.1093/eurheartj/ehac530

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