Time from admission to randomization and the effect of empagliflozin in acute heart failure: a post-hoc analysis from EMPULSE
Aims Patients hospitalized for acute heart failure (HF) could be enrolled in EMPULSE (NCT04157751) upon haemodynamic stabilization and between 24 h and 5 days after hospital admission. The timing of treatment initiation may influence the efficacy and safety of drugs such as empagliflozin. The aim of...
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| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
September 2024
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| In: |
European journal of heart failure
Year: 2024, Volume: 26, Issue: 9, Pages: 1976-1983 |
| ISSN: | 1879-0844 |
| DOI: | 10.1002/ejhf.3369 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1002/ejhf.3369 Verlag, kostenfrei, Volltext: http://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.3369 
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| Author Notes: | João Pedro Ferreira, Jonathan P. Blatchford, John R. Teerlink, Mikhail N. Kosiborod, Christiane E. Angermann, Jan Biegus, Sean P. Collins, Jasper Tromp, Michael E. Nassif, Mitchell A. Psotka, Josep Comin-Colet, Robert J. Mentz, Martina Brueckmann, Matias Nordaby, Piotr Ponikowski, and Adriaan A. Voors |
MARC
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| 245 | 1 | 0 | |a Time from admission to randomization and the effect of empagliflozin in acute heart failure |b a post-hoc analysis from EMPULSE |c João Pedro Ferreira, Jonathan P. Blatchford, John R. Teerlink, Mikhail N. Kosiborod, Christiane E. Angermann, Jan Biegus, Sean P. Collins, Jasper Tromp, Michael E. Nassif, Mitchell A. Psotka, Josep Comin-Colet, Robert J. Mentz, Martina Brueckmann, Matias Nordaby, Piotr Ponikowski, and Adriaan A. Voors |
| 264 | 1 | |c September 2024 | |
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| 520 | |a Aims Patients hospitalized for acute heart failure (HF) could be enrolled in EMPULSE (NCT04157751) upon haemodynamic stabilization and between 24 h and 5 days after hospital admission. The timing of treatment initiation may influence the efficacy and safety of drugs such as empagliflozin. The aim of this study was to evaluate patient characteristics, clinical events, and treatment effects according to time from admission to randomization. Methods and results The EMPULSE population was dichotomized by median time from hospital admission to randomization (1-2 days vs. 3-5 days). The primary outcome was a hierarchical composite endpoint of time to all-cause death, number of HF events, time to first HF event, and a ≥5-point difference in Kansas City Cardiomyopathy Questionnaire total symptom score change from baseline after 90 days, analysed using the win ratio (WR) method. Patients randomized later (3-5 days, average time 3.9 days; n = 312) had a higher risk of experiencing clinical events than patients randomized earlier (1-2 days, average time 1.7 days; n = 215). The treatment effect favoured empagliflozin versus placebo in patients randomized later (3-5 days: WR 1.69, 95% confidence interval [CI] 1.26-2.25) but was attenuated in patients randomized earlier (1-2 days: WR 1.04, 95% CI 0.74-1.44) (interaction p = 0.029). A similar pattern was observed for the composite of HF hospitalization or cardiovascular death and all-cause hospitalizations (interaction p < 0.1 for both). The reduction of N-terminal pro-B-type natriuretic peptide levels was more pronounced with empagliflozin among patients randomized later than in patients randomized earlier (interaction p = 0.004). Conclusions Among patients hospitalized for acute HF enrolled in EMPULSE, those randomized later after hospital admission (3-5 days) experienced greater clinical benefit with empagliflozin than those randomized earlier (1-2 days). These findings should be confirmed in future studies before clinical application. | ||
| 650 | 4 | |a Acute heart failure | |
| 650 | 4 | |a Empagliflozin | |
| 650 | 4 | |a Timing of randomization | |
| 700 | 1 | |a Blatchford, Jonathan P. |e VerfasserIn |4 aut | |
| 700 | 1 | |a Teerlink, John R. |e VerfasserIn |4 aut | |
| 700 | 1 | |a Kosiborod, Mikhail N. |e VerfasserIn |4 aut | |
| 700 | 1 | |a Angermann, Christiane E. |e VerfasserIn |4 aut | |
| 700 | 1 | |a Biegus, Jan |e VerfasserIn |4 aut | |
| 700 | 1 | |a Collins, Sean P. |e VerfasserIn |4 aut | |
| 700 | 1 | |a Tromp, Jasper |e VerfasserIn |4 aut | |
| 700 | 1 | |a Nassif, Michael E. |e VerfasserIn |4 aut | |
| 700 | 1 | |a Psotka, Mitchell A. |e VerfasserIn |4 aut | |
| 700 | 1 | |a Comin-Colet, Josep |e VerfasserIn |4 aut | |
| 700 | 1 | |a Mentz, Robert J. |e VerfasserIn |4 aut | |
| 700 | 1 | |a Brückmann, Martina |d 1970- |e VerfasserIn |0 (DE-588)121145069 |0 (DE-627)705257290 |0 (DE-576)292557736 |4 aut | |
| 700 | 1 | |a Nordaby, Matias |e VerfasserIn |4 aut | |
| 700 | 1 | |a Ponikowski, Piotr |e VerfasserIn |4 aut | |
| 700 | 1 | |a Voors, Adriaan A. |e VerfasserIn |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t European journal of heart failure |d Oxford : Wiley, 1999 |g 26(2024), 9 vom: Sept., Seite 1976-1983 |h Online-Ressource |w (DE-627)306658291 |w (DE-600)1500332-2 |w (DE-576)081985983 |x 1879-0844 |7 nnas |a Time from admission to randomization and the effect of empagliflozin in acute heart failure a post-hoc analysis from EMPULSE |
| 773 | 1 | 8 | |g volume:26 |g year:2024 |g number:9 |g month:09 |g pages:1976-1983 |g extent:8 |a Time from admission to randomization and the effect of empagliflozin in acute heart failure a post-hoc analysis from EMPULSE |
| 787 | 0 | 8 | |i Ergänzung |a Hu, Yue |t Empagliflozin and glucagon-like peptide-1 receptor agonists: The brothers for heart failure? Letter regarding the article ‘Time from admission to randomization and the effect of empagliflozin in acute heart failure: A post-hoc analysis from EMPULSE’, in: European Journal of Heart Failure |d 2024 |g 2024, 2296-2297 |o 10.1002/ejhf.3419 |
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