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Treatment effects of empagliflozin in hospitalized heart failure patients across the range of left ventricular ejection fraction: results from the EMPULSE trial

Aim The EMPULSE (EMPagliflozin in patients hospitalised with acUte heart faiLure who have been StabilizEd) trial showed that, compared to placebo, the sodium-glucose cotransporter 2 inhibitor empagliflozin (10 mg/day) improved clinical outcomes of patients hospitalized for acute heart failure (HF)....

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Main Authors: Tromp, Jasper (Author) , Kosiborod, Mikhail N. (Author) , Angermann, Christiane E. (Author) , Collins, Sean P. (Author) , Teerlink, John R. (Author) , Ponikowski, Piotr (Author) , Biegus, Jan (Author) , Ferreira, João Pedro (Author) , Nassif, Michael E. (Author) , Psotka, Mitchell A. (Author) , Brückmann, Martina (Author) , Blatchford, Jonathan P (Author) , Steubl, Dominik (Author) , Voors, Adriaan A. (Author)
Format: Article (Journal)
Language:English
Published: April 2024
In: European journal of heart failure
Year: 2024, Volume: 26, Issue: 4, Pages: 963-970
ISSN:1879-0844
DOI:10.1002/ejhf.3218
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1002/ejhf.3218
Verlag, kostenfrei, Volltext: http://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.3218
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Author Notes:Jasper Tromp, Mikhail N. Kosiborod, Christiane E. Angermann, Sean P. Collins, John R. Teerlink, Piotr Ponikowski, Jan Biegus, João Pedro Ferreira, Michael E. Nassif, Mitchell A. Psotka, Martina Brueckmann, Jonathan P Blatchford, Dominik Steubl, and Adriaan A. Voors
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Summary:Aim The EMPULSE (EMPagliflozin in patients hospitalised with acUte heart faiLure who have been StabilizEd) trial showed that, compared to placebo, the sodium-glucose cotransporter 2 inhibitor empagliflozin (10 mg/day) improved clinical outcomes of patients hospitalized for acute heart failure (HF). We investigated whether efficacy and safety of empagliflozin were consistent across the spectrum of left ventricular ejection fraction (LVEF). Methods and results A total of 530 patients hospitalized for acute de novo or decompensated HF were included irrespective of LVEF. For the present analysis, patients were classified as HF with reduced (HFrEF, LVEF ≤40%), mildly reduced (HFmrEF, LVEF 41-49%) or preserved (HFpEF, LVEF ≥50%) ejection fraction at baseline. The primary endpoint was a hierarchical outcome of death, worsening HF events (HFE) and quality of life over 90 days, assessed by the win ratio. Secondary endpoints included individual components of the primary endpoint and safety. Out of 523 patients with baseline data, 354 (67.7%) had HFrEF, 54 (10.3%) had HFmrEF and 115 (22.0%) had HFpEF. The clinical benefit (hierarchical composite of all-cause death, HFE and Kansas City Cardiomyopathy Questionnaire total symptom score) of empagliflozin at 90 days compared to placebo was consistent across LVEF categories (≤40%: win ratio 1.35 [95% confidence interval 1.04, 1.75]; 41-49%: win ratio 1.25 [0.66, 2.37)] and ≥50%: win ratio 1.40 [0.87, 2.23], pinteraction = 0.96) with a favourable safety profile. Results were consistent across individual components of the hierarchical primary endpoint. Conclusion The clinical benefit of empagliflozin proved consistent across LVEF categories in the EMPULSE trial. These results support early in-hospital initiation of empagliflozin regardless of LVEF.
Item Description:Erstmals veröffentlicht: 04. April 2024
Gesehen am 03.02.2025
Physical Description:Online Resource
ISSN:1879-0844
DOI:10.1002/ejhf.3218

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