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Effect of Empagliflozin Based on Recency of HF Hospitalization
Quick Takes
- In a pooled analysis of EMPEROR-Preserved and EMPEROR-Reduced, enrolled patients with a recent HF hospitalization had higher risk profiles with greater symptom and comorbidity burden.
- The effect of empagliflozin for both cardiac and renal protection did not differ by recency of HF hospitalization prior to enrollment.
Study Questions:
Does the effect of empagliflozin in heart failure (HF) vary based on timing since prior HF hospitalization?
Methods:
The authors pooled data from randomized trials looking at use of empagliflozin in HF with preserved ejection fraction (EF) (EMPEROR-Preserved) and in HF with reduced EF (EMPEROR-Reduced). Both trials included adults with New York Heart Association class II-IV symptoms for 3 months. Endpoints included a composite of cardiovascular death or HF hospitalization, composite of all HF hospitalizations and mortality, sustained decline in estimated glomerular filtration rate (eGFR) ≥40% or ≥50% from baseline, chronic dialysis or renal transplant or renal death, changes in annualized eGFR slope, and drug adverse events.
Results:
Overall, 9,718 patients were included in this study and only 2.8% had a hospitalization within the last 30 days. Patients with more recent HF hospitalization were more likely to be younger, Asian, men, have a lower EF, high N-terminal pro–B-type natriuretic peptide, higher heart rate, lower blood pressure, have atrial fibrillation, diabetes mellitus, and more likely to be treated with loop diuretics, angiotensin receptor-neprilysin inhibitors, and mineralocorticoid receptor antagonists. Event rates were higher the more recent the last HF hospitalization was. Adverse events were more common among patients with more recent HF hospitalization. However, the effect of empagliflozin in reducing all endpoints (both cardiac and renal) did not vary based on timing of last HF hospitalization.
Conclusions:
In a pooled analysis of trials looking at effect of empagliflozin in HFrEF and HFpEF, the effect of empagliflozin did not vary based on time since last HF hospitalization.
Perspective:
Several studies demonstrate that even a single HF hospitalization is associated with a higher risk for adverse events including death in the time period following discharge. In a pooled analysis of EMPEROR-Reduced and EMPEROR-Preserved, the authors noted similar findings. Enrolled patients with a recent HF hospitalization had a higher risk profile with more symptoms and more comorbidities. However, risk reduction for all endpoints associated with empagliflozin did not vary based on timing since last HF hospitalization. Although the proportion of patients with a HF hospitalization within the last 30 days prior to enrollment was small at under 3%, these data suggest that empagliflozin should be initiated as early as possible during or after an HF hospitalization.
Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Heart Failure and Cardiac Biomarkers
Keywords: Atrial Fibrillation, Blood Pressure, Diabetes Mellitus, Glomerular Filtration Rate, Heart Failure, Hospitalization, Natriuretic Peptide, Brain, Patient Discharge, Pharmaceutical Preparations, Renal Dialysis, Renal Insufficiency, Risk, Stroke Volume
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