Heart failure & cardiomyopathies
Early versus delayed or no empagliflozin initiation after hospitalisation for heart failure in the United States: A target trial emulation
Authors' conclusion
Early empagliflozin initiation was associated with lower risks of 1-year post-discharge all-cause mortality, worsening HF events, and all-cause hospitalisations compared with delayed or no initiation, and with lower acute care utilisation rates compared with no initiation.
Study context
- Population
- Adults hospitalised for Heart Failure (HF) between September 2021 and December 2023, Optum de-identified Clinformatics Data Marteligible patients, mean age 78.0 [9.2] years, 54.2% female
- Participants
- 99,738 adults
- Exposure
- Timing of empagliflozin initiation: early and intermediate vs delayed or no initiation
- Outcome
- All-cause mortality
- Follow-up
- 1 year post-discharge
Methodological detailstarget trial emulation, clone-censor-weight approach, landmark analyses at Days 7 and 91 post-discharge
- Target trial emulation
- Clone-censor-weight approach
- Landmark analyses at Days 7 and 91 post-discharge
Main finding
As reported in the abstract
Each group vs delayed or no initiationRelative risk (95% CI)
Early
0.73(0.69–0.78)
Intermediate
0.93(0.89–0.97)
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | |
|---|---|---|
| Worsening HF events, HF rehospitalisations, ED visits, all-cause hospitalisations · 1 year post-dischargeEarlyvs delayed or no initiationWorsening HF events | RR 0.89 (95% CI 0.84–0.94) | |
| Worsening HF events, HF rehospitalisations, ED visits, all-cause hospitalisations · 1 year post-dischargeEarlyvs delayed or no initiationHF rehospitalisations | RR 0.86 (95% CI 0.81–0.92) | |
| Worsening HF events, HF rehospitalisations, ED visits, all-cause hospitalisations · 1 year post-dischargeEarlyvs delayed or no initiationEmergency department (ED) visits | RR 0.87 (95% CI 0.82–0.93) | |
| Worsening HF events, HF rehospitalisations, ED visits, all-cause hospitalisations · 1 year post-dischargeEarlyvs delayed or no initiationAll-cause hospitalisations | RR 0.91 (95% CI 0.88–0.94) | |
| Acute care utilisation (landmark analysis) · 7 days analysisEarlyvs no initiationAll-cause hospitalisations · landmark analyses | IRR 0.80 (95% CI 0.77–0.84) | |
| Acute care utilisation (landmark analysis) · 7 days analysisEarlyvs no initiationHF-related hospitalisations · landmark analyses | IRR 0.76 (95% CI 0.70–0.83) | |
| Acute care utilisation (landmark analysis) · 7 days analysisEarlyvs no initiationAll-cause ED visits · landmark analyses | IRR 0.87 (95% CI 0.83–0.91) | |
| Acute care utilisation (landmark analysis) · 7 days analysisEarlyvs no initiationHF-related ED visits · landmark analyses | IRR 0.78 (95% CI 0.72–0.86) | |
| 0.512Ratio (log scale) |
Worsening HF events, HF rehospitalisations, emergency department (ED) visits, all-cause hospitalisations · 1 year post-discharge
- Associations for intermediate initiation were in the same direction but smaller in magnitude
Original publication
Early versus delayed or no empagliflozin initiation after hospitalisation for heart failure in the United States: A target trial emulation. ESC Heart Fail. Published 22 September 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →