Empagliflozin Initiation in Hospital Benefits both new onset and acute decompensated HF Patients: Study

A new study published in the journal of JACC: Heart Failure showed that despite a decreased diuretic response in patients with acute decompensated heart failure (ADHF), in-hospital empagliflozin start had comparable therapeutic improvements in both de novo heart failure (NHF) and ADHF.

The SGLT2 inhibitor empagliflozin has become a mainstay treatment for heart failure, showing notable advantages for a wide range of patients. Its effectiveness in acute settings has been the subject of recent clinical research, particularly when comparing the outcomes of patients who present with ADHF vs de novo heart failure.

Early in-hospital beginning of empagliflozin has shown safe, efficacious, and well-tolerated for both groups, despite differences in the underlying pathophysiology and first symptoms. Empagliflozin enhanced clinical outcomes in patients admitted for heart failure (HF) in EMPULSE (A Study to Test the Effect of Empagliflozin in Patients Who Are in Hospital for Acute Heart Failure). The effectiveness, safety, and tolerability of empagliflozin were compared between subgroups with NHF and ADHF in this prespecified investigation.

Following stabilization, participants were stratified by HF status (NHF: n = 175; ADHF: n = 355) and randomly assigned 1:1 to either empagliflozin 10 mg/d or placebo. A hierarchical composite of death, worsening heart failure, or a ≥5-point change in the Kansas City Cardiomyopathy Questionnaire-Total Symptom Score (KCCQ-TSS) at day 90 was the main outcome, and it was evaluated using a win ratio.

Individuals with NHF had superior KCCQ-TSS, were younger, had less comorbidities, and had greater heart rate and blood pressure. Diuretic medication prescriptions were comparable across subgroups. For NHF and ADHF, the win ratios were 1.29 (95% CI: 0.89-1.89) and 1.39 (95% CI: 1.07-1.81), respectively (Pinteraction = 0.759).

With the exception of diuretic response, which was higher in NHF than in ADHF starting on day 15 (mean difference vs placebo: -5.11 [Q1-Q3: -7.89 to -2.32] vs -0.97 [Q1-Q3: -2.91 to 0.96] kg per mean daily loop diuretic dose, Pinteraction = 0.017), there were no interactions between NHF and ADHF.

When compared to a placebo, the frequency of adverse events was consistently reduced with empagliflozin. Overall, starting empagliflozin during a hospitalization resulted in similar beneficial health outcomes for individuals with NHF and ADHF. 

Reference:

Angermann, C. E., Gerhardt, T., Blatchford, J. P., Biegus, J., Collins, S. P., Kosiborod, M., Ferreira, J. P., Nassif, M. E., Psotka, M. A., Tromp, J., Kraus, B. J., Ponikowski, P., Teerlink, J. R., & Voors, A. A. (2026). Empagliflozin in De Novo vs Acute Decompensated Chronic Heart Failure: A Prespecified Analysis From EMPULSE. JACC. Heart Failure, 102999. https://doi.org/10.1016/j.jchf.2026.102999