Points
- Administering empagliflozin to acute HF patients improved KCCQ versus placebo across the KCCQ baseline, and sustained its benefit across 90 days of study
- Early SLGT2 inhibitor treatment may impart benefits to both symptom improvement and QoL for acute HF patients transitioning to an outpatient setup
Summary
Acute heart failure (HF) remains to be a particular point of concern among health experts despite advances in medical therapy over the years. Acute HF currently maintains a high rate of morbidity and mortality (Tromp et al, 2020). Sodium-glucose cotransporter 2 (SLGT2) inhibitors have previously been shown to reduce the rate of hospitalization and mortality in patients with chronic HF; Vaduganathan et al (2022) managed to show such across the spectrum of left ventricular ejection fraction (LVEF).
Recently, the EMPULSE trial showed the benefits of employing empagliflozin versus placebo in acute HF; this was irrespective of either LVEF or chronicity of HF diagnosis (Voors et al, 2022). Following this, a secondary analysis showed empagliflozin’s effects on acute HF patient symptoms and quality of life (QoL) (Kosiborod et al, 2022).
Patients with acute HF were randomized to either a daily 10 mg dosage of empagliflozin or a placebo for 90 days; these patients were selected regardless of ejection fraction. From there, factors such as symptoms, physical limitations, and QoL were assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ) at randomization and was given to patients at 15, 30, and 90 days after the first empagliflozin medication From there, it was seen that empagliflozin improved KCCQ versus placebo across the entire KCCQ baseline range; this was seen even as early as 15 days post-randomization, and persisted through the 90 days of the trial. These KCCQ results were considered regardless of the degree of symptomatic impairment at baseline.
EMPULSE was among the first to show the improvements imparted by a pharmacologic agent in acute HF alongside a sustained benefit for 90 days. This improvement was seen across the LVEF spectrum, as well as both de novo acute systolic HF and in acute decompensations of chronic HF. The EMPULSE trial, therefore, highlights the importance of starting SLGT2 inhibitors as early as the inpatient setting, especially given the potential benefits in outpatient transition for HF patients in terms of QoL and symptom improvement.
References Kosiborod, M. N., Angermann, C. E., Collins, S. P., Teerlink, J. R., Ponikowski, P., Biegus, J., Comin-Colet, J., Ferreira, J. P., Mentz, R. J., Nassif, M. E., Psotka, M. A., Tromp, J., Brueckmann, M., Blatchford, J. P., Salsali, A., & Voors, A. A. (2022). Effects of empagliflozin on symptoms, physical limitations, and quality of life in patients hospitalized for acute heart failure: Results from the empulse trial. Circulation, 146(4), 279–288. https://doi.org/10.1161/CIRCULATIONAHA.122.059725 Tromp, J., Bamadhaj, S., Cleland, J. G. F., Angermann, C. E., Dahlstrom, U., Ouwerkerk, W., Tay, W. T., Dickstein, K., Ertl, G., Hassanein, M., Perrone, S. V., Ghadanfar, M., Schweizer, A., Obergfell, A., Lam, C. S. P., Filippatos, G., & Collins, S. P. (2020). Post-discharge prognosis of patients admitted to hospital for heart failure by world region, and national level of income and income disparity (Report-hf): A cohort study. The Lancet Global Health, 8(3), e411–e422. https://doi.org/10.1016/S2214-109X(20)30004-8 Vaduganathan, M., Claggett, B. L., Inciardi, R. M., Fonarow, G. C., McMurray, J. J. V., & Solomon, S. D. (2022). Estimating the benefits of combination medical therapy in heart failure with mildly reduced and preserved ejection fraction. Circulation, 145(23), 1741–1743. https://doi.org/10.1161/CIRCULATIONAHA.121.058929 Voors, A. A., Angermann, C. E., Teerlink, J. R., Collins, S. P., Kosiborod, M., Biegus, J., Ferreira, J. P., Nassif, M. E., Psotka, M. A., Tromp, J., Borleffs, C. J. W., Ma, C., Comin-Colet, J., Fu, M., Janssens, S. P., Kiss, R. G., Mentz, R. J., Sakata, Y., Schirmer, H., … Ponikowski, P. (2022). The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: A multinational randomized trial. Nature Medicine, 28(3), 568–574. https://doi.org/10.1038/s41591-021-01659-1
