Effects of Empagliflozin on Symptoms, Physical Limitations and Quality of Life in Patients Hospitalized for Acute Heart Failure – Results From the EMPULSE Trial
Circulation 2022; online ahead of print doi:10.1161/CIRCULATIONAHA.122.059725
This post hoc and prespecified analysis of the EMPULSE trial found that initiation of empagliflozin in patients hospitalised for acute heart failure (AHF) produced clinical benefit regardless of the degree of symptomatic impairment at baseline. Empagliflozin also improved symptoms, physical limitations, and quality of life – with benefits seen as early as 15 days and maintained through 90 days.
Patients hospitalised for AHF experience poor health status, including high burden of symptoms, physical limitations, and poor quality of life. Sodium-glucose co-transporter-2 inhibitors (SGLT2i) improve health status in chronic HF, but their impact on these outcomes in acute HF is not well characterised. EMPULSE was a randomised, double-blind, placebo-controlled trial to evaluate the efficacy and safety of once-daily empagliflozin 10 mg compared with placebo, when added to standard care. This prespecified post hoc analysis examined the effects of empagliflozin across tertiles of baseline total symptom scores (TSS) on the Kansas City Cardiomyopathy Questionnaire (KCCQ).
The primary outcome was a hierarchical composite of clinical benefit. Results showed patients treated with empagliflozin experienced greater clinical benefit across the range of KCCQ-TSS, with no evidence of treatment effect heterogeneity. The effects were generally consistent across pre-specified demographic and clinical subgroups. These observations are of clinical relevance as very few therapies have been shown to improve symptoms and functional status in the early post-discharge period in patients hospitalised with AHF.