Heart failure & cardiomyopathiesSecondary analysis
Empagliflozin in De Novo vs Acute Decompensated Chronic Heart Failure
- Secondary analysis of the EMPULSE randomised trial
- prespecified subgroup analysis
- stratified by heart failure (HF) status
Authors' conclusion
In-hospital initiation of empagliflozin produced similar clinical benefits in NHF and ADHF despite the reduced diuretic response in participants with ADHF and was well tolerated.
Study context
- Population
- Patients hospitalised for acute HF, after stabilisation, by subgroup: de novo HF (novo heart failure (NHF), n = 175) or acute decompensated HF (acute decompensated heart failure (ADHF), n = 355)NHF n = 175
- Comparison
- Empagliflozin vs placebo in de novo HF vs acute decompensated chronic HF
- Primary endpoint
- Hierarchical composite of:
- Death
- Worsening HF
- ≥5-point difference in Kansas City Cardiomyopathy Questionnaire-Total Symptom Score (KCCQ-TSS) change
- Follow-up
- Day 90
Primary result
As reported in the abstract
Hierarchical composite (death, worsening HF, ≥5-point KCCQ-TSS change) by win ratio, empagliflozin vs placebo, by subgroup
Each group vs placeboWin ratio (95% CI)
NHFde novo HF subgroup
1.29(0.89–1.89)
ADHFacute decompensated HF subgroup
1.39(1.07–1.81)
Secondary outcomes
| Outcome | mean difference (kg per mean daily loop diuretic dose) (Q1-Q3 CI) | |
|---|---|---|
| Diuretic response (kg per mean daily loop diuretic dose), by HF status · from day 15 — Empagliflozin vs Placebo · NHF · greater with empagliflozin in NHF than in ADHF | −5.11 (−7.89 to −2.32) | |
| Diuretic response (kg per mean daily loop diuretic dose), by HF status · from day 15 — Empagliflozin vs Placebo · ADHF · greater with empagliflozin in NHF than in ADHF | −0.97 (−2.91 to 0.96) | |
| −10−505Difference, kg per mean daily loop diuretic dose (linear scale) |
- Diuretic response (kg per mean daily loop diuretic dose), by HF status: Pinteraction = 0.017
Primary endpoint components and secondary endpoints, by HF status
- No interactions between NHF and ADHF, except diuretic response
Diuretic response (kg per mean daily loop diuretic dose), by HF status · from day 15
- Even greater between-group differences at days 30 and 90
Safety
Adverse events
- Frequencies of adverse events consistently lower with empagliflozin vs placebo
Original publication
Empagliflozin in De Novo vs Acute Decompensated Chronic Heart Failure. JACC Heart Fail. Published 7 March 2026. doi:10.1016/j.jchf.2026.102999
Summarised from the published abstract; every number is checked against it