EMPULSE: Empagliflozin delivers rapid and clinically meaningful decongestion

The initiation of empagliflozin therapy in patients who were hospitalised for acute heart failure (HF) was associated with early, clinically meaningful, and sustainable decongestion. This was the main outcome of the EMPULSE trial.

The EMPULSE trial (NCT04157751) randomised 530 patients with stabilised acute HF to empagliflozin or placebo. Empagliflozin outperformed placebo concerning the primary endpoint of this study, a composite of all-cause death, HF events, and Kansas City Cardiomyopathy Questionnaire – Total Symptom Score (KCCQ-TSS) change from baseline [1]. The current analysis, presented by Prof. Piotr Ponikowski (Medical University of Wroclaw, Poland), assessed the decongestive effects of empagliflozin compared with placebo [2]. “This analysis is important, as congestion presents the main reason for hospitalisation in patients with acute decompensated HF,” added Prof. Ponikowski [3]. Weight loss measured on day 15, 30, and 90 was the primary outcome to assess decongestion.

Prof. Ponikowski showed that the weight loss on day 15 (P<0.0001) and day 30 (P=0.0004) indeed correlated significantly with positive effects in the primary outcome of the EMPULSE trial. Weight loss was significantly larger on days 15, 30, and 90 in participants treated with empagliflozin than in participants who received placebo, with an adjusted mean differences of -1.97 kg (P<0.0001), -1.74 kg (P=0.0007), and -1.53 kg (P=0.0137), respectively. Correspondingly, change in body weight per mean daily dose of loop diuretic favoured the empagliflozin arm over the placebo arm on day 15 (adjusted mean difference 2.31 kg; P=0.002), day 30 (-2.79 kg; P=0.0152), and at day 90 (-3.18 kg; P=0.0319). Furthermore, the NT-proBNP levels of participants in the empagliflozin arm were significantly reduced compared with placebo users at all 3 timepoints.

“In patients who were hospitalised for acute HF, empagliflozin therapy evoked an early and clinically meaningful decongestion that, importantly, was maintained until day 90,” summarised Prof. Ponikowski the results of the current analysis.

1. Voors AA, et al. Nat Med. 2022;28(3):568–574.
2. Biegus J, et al. EMPULSE – Empagliflozin in patients hospitalized with acute heart failure who have been stabilized. LBT Pharmacological treatment II, Heart Failure 2022, 21–24 May, Madrid, Spain.
3. Chioncel O, et al. Eur J Heart Fail. 2017;19(10):1242–1254.

 

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Posted on 28 July 2022