The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure
Nature Medicine, 2022 · Multinational double-blind randomized placebo-controlled trial (n=530)
Clinical question
Does starting empagliflozin after clinical stabilization during an acute heart-failure hospitalization improve 90-day clinical benefit?
What the trial found
Starting empagliflozin in clinically stabilized patients during an acute heart-failure admission improved a 90-day hierarchical composite of survival, heart-failure events and symptoms.
Clinical interpretation
Supports in-hospital initiation of empagliflozin after stabilization; do not extrapolate EMPULSE to dapagliflozin or claim that it independently reduced mortality.
Hemodynamic phenotypes (SCAPE vs ADHF vs Cardiogenic Shock), non-invasive positive pressure ventilation, high-dose vasodilator algorithms, loop diuretics, and sequential nephron blockade.
Hydrostatic pulmonary edema physiology, SCAPE vs decompensated HF vs cardiogenic shock, NIV, titrated vasodilators when hypertensive, diuresis, and sequential nephron blockade.