Mineralocorticoid Receptor Antagonist Use and the Effects of Empagliflozin on Clinical Outcomes in Patients Admitted for Acute Heart Failure: Findings from EMPULSE
Eur J Heart Fail. 2023; online ahead of print DOI: 10.1002/ejhf.2982
In the EMPULSE trial, empagliflozin produced greater clinical benefit than placebo in patients hospitalised for AHF. Although many patients with AHF are treated with MRAs, the interplay between empagliflozin and MRAs in AHF has not been explored. A post-hoc analysis of the EMPULSE trial aimed to evaluate the efficacy and safety of empagliflozin versus placebo according to MRA use at baseline.
In EMPULSE, slightly more than half (52%) of patients were receiving MRAs at baseline. MRA users were younger, had lower LVEF, better renal function and higher KCCQ scores. Irrespective of baseline MRA use, initiation of empagliflozin produced beneficial effects on the primary outcome of all-cause death, HF events and a ≥5 point difference in KCCQ total symptom score at 90 days compared with placebo. Empagliflozin had a favourable safety profile regardless of baseline MRA use. Furthermore, investigator-reported and severe hyperkalaemia were infrequent with empagliflozin, and did not differ by MRA use at baseline. The authors concluded that these findings support the early use of empagliflozin on top of MRA therapy in patients admitted for AHF.
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