Don't Delay – Starting Empagliflozin During Acute Heart Failure Hospitalization

Despite the advances in medical therapy in patients with chronic heart failure (HF) over the recent years, acute HF remains a vexing problem, with high rates of morbidity and mortality.1 Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to reduce hospitalization and mortality in patients with chronic HF across the spectrum of left ventricular ejection fraction (LVEF).2 The EMPULSE trial recently demonstrated the clinical benefit of empagliflozin versus placebo in acute HF irrespective of LVEF or chronicity of HF diagnosis.3 A secondary analysis from the trial investigated the impact of empagliflozin on symptoms and quality of life in patients hospitalized with acute HF.4

Patients hospitalized with acute HF regardless of ejection fraction were randomized to empagliflozin 10mg daily or placebo for 90 days. Symptoms, physical limitations, and quality of life were assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ) at randomization and 15, 30, and 90 days. Not only did empagliflozin significantly improve KCCQ versus placebo, but this benefit was also seen across the entire range of baseline KCCQ, regardless of the degree of symptomatic impairment at baseline. These outcomes were seen as early as 15 days post randomization and persisted through 90 days.

The EMPULSE trial is one of the first clinical trials to show symptomatic improvement with a pharmacologic agent in acute HF, with sustained benefit up to 90 days. This finding was seen across the spectrum of LVEF and in both de novo acute systolic HF and in acute decompensations of chronic HF. This trial highlights the importance of starting SGLT2 inhibitors during the inpatient setting. Furthermore, the improvement in symptoms and quality of life may ease the transition of HF patients from the hospital to the outpatient environment.


  1. Tromp J, Bamadhaj S, Cleland JGF, et al. 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. Lancet Glob Health 2022;8:e411-22. 
  2. Vaduganathan M, Claggett BL, Inciardi RM, Fonarow GC, McMurray JJV, Solomon SD. Estimating the benefits of combination medical therapy in heart failure with mildly reduced and preserved ejection fraction. Circulation 2022;145:1741-43.
  3. Voors AA, Angermann CE, Teerlink JR, et al. The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial. Nat Med 2022;28:568-74.
  4. Kosiborod MN, Angermann CE, Collins SP, et al.  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;Apr 4:[Epub ahead of print].

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: ACC22, ACC Annual Scientific Session, Heart Failure, Sodium-Glucose Transporter 2 Inhibitors, Stroke Volume, Quality of Life, Inpatients, Outpatients, Random Allocation, Ventricular Function, Left, Hospitalization, Cardiomyopathies, Morbidity, Hospitals, Glucose, Sodium

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