Heart failure & cardiomyopathiesCohort study
Early versus delayed or no empagliflozin initiation after hospitalisation for heart failure in the United States: A target trial emulation
- retrospective cohort study
- target trial emulation
- clone-censor-weight approach
- landmark analyses at Days 7 and 91 post-discharge
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
Main finding
As reported in the abstract
All-cause mortality · 1 year post-discharge
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-discharge — early vs delayed or no initiation · worsening HF events | RR 0.89 (95% CI 0.84–0.94) | |
| Worsening HF events, HF rehospitalisations, ED visits, all-cause hospitalisations · 1 year post-discharge — early vs delayed or no initiation · HF rehospitalisations | RR 0.86 (95% CI 0.81–0.92) | |
| Worsening HF events, HF rehospitalisations, ED visits, all-cause hospitalisations · 1 year post-discharge — early vs delayed or no initiation · emergency 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-discharge — early vs delayed or no initiation · all-cause hospitalisations | RR 0.91 (95% CI 0.88–0.94) | |
| Acute care utilisation (landmark analysis) · 7 days analysis — early vs no initiation · all-cause hospitalisations · landmark analyses | IRR 0.80 (95% CI 0.77–0.84) | |
| Acute care utilisation (landmark analysis) · 7 days analysis — early vs no initiation · HF-related hospitalisations · landmark analyses | IRR 0.76 (95% CI 0.70–0.83) | |
| Acute care utilisation (landmark analysis) · 7 days analysis — early vs no initiation · all-cause ED visits · landmark analyses | IRR 0.87 (95% CI 0.83–0.91) | |
| Acute care utilisation (landmark analysis) · 7 days analysis — early vs no initiation · HF-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:10.1093/eschf/xvag242
Summarised from the published abstract; every number is checked against it