Journal Club - Empagliflozin to Improve Heart Failure Symptoms

Patients hospitalized for acute heart failure (AHF) experience poor health status, including high burden of symptoms and physical limitations, and poor quality of life. We have previously Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve health status in chronic HF, but their impact on these outcomes in AHF are not well characterized.    

Effects of Empagliflozin on Symptoms, Physical Limitations and Quality of Life in Patients Hospitalized for Acute Heart Failure as shown in the Results From the EMPULSE Trial.

Empagliflozin we all know is a class of medications called sodium-glucose co-transporter 2 (SGLT2) inhibitors. It is used to reduce the risk of stroke, heart attack, or death in people who have type 2 diabetes along with heart and blood vessel disease.

Now the EMPULSE trial investigated the effects of the SGLT2 inhibitor empagliflozin on symptoms, physical limitations and quality of life, using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Treatment of patients acutely hospitalized for heart failure with the SGLT2 inhibitor empagliflozin led to a rapid incremental increase in patient well-being, compared with control patients who received placebo, that appeared after 2 weeks on treatment in a secondary analysis from 530 randomized patients in the EMPULSE trial.

EMPULSE was presented as new analysis at the annual scientific sessions of the American College of Cardiology, the message from the quick response of acutely hospitalized patients to empagliflozin was Clear- which was the "Use of these medications, SGLT2 inhibitors, as early as possible." They have seen with other medications that if they are not prescribed during hospitalization it's unlikely to happen post discharge.

Researchers observed with empagliflozin at 15 days is the first such observation, and if corroborated by future studies would suggest that initiation of SGLT2 inhibitors during hospitalization for acute heart failure may be a tool for improving the quality of hospital-to-home transitions. The primary outcome for EMPULSE was a combined endpoint of "total clinical endpoints" that included all-cause mortality, heart failure events (heart failure hospitalizations, urgent heart failure visits, and unplanned outpatient heart failure visits).

Using a "win ratio" method for analyzing the composite endpoint, the primary analysis showed that treatment with empagliflozin for 90 days boosted the win ratio by a significant 36% relative to placebo. The results showed that the degree of improvement for the primary, 90-day outcome of "total clinical benefit" compared with placebo was consistent, showing that empagliflozin's benefit was "independent of symptomatic impairment.

Hence the researchers concluded that treatment of patients with heart failure is geared to making patients live longer and stay out of the hospital. Enabling patients to feel better is an equally important goal of management, but not all treatments for heart failure can do that.