Heart failure & cardiomyopathiesSecondary analysis
Mineralocorticoid Receptor Antagonist Use and the Effects of Empagliflozin on Clinical Outcomes in Patients Admitted for Acute Heart Failure: Findings from EMPULSE
- Secondary analysis of the EMPULSE randomised trial
- subgroup analysis by baseline MRA use
Authors' conclusion
In patients admitted for AHF, initiation of empagliflozin produced clinical benefit and was well tolerated irrespective of background MRA use.
Study context
- Population
- Patients hospitalised for acute HF, stratified by baseline MRA use276 (52%) on mineralocorticoid receptor antagonists (MRAs)
- Participants
- 530 patients
- Comparison
- Empagliflozin vs placebo, by baseline MRA use
- Primary endpoint
- All-cause death, HF events and ≥5 point difference in Kansas City Cardiomyopathy Questionnaire (KCCQ) total symptom score, assessed by win ratio
- Follow-up
- 90 days
Primary result
As reported in the abstract
Primary outcome (win ratio) by baseline MRA use
Win ratio (WR)
- MRA users
- 1.46 (95% CI 1.08–1.97)
- MRA non-users
- 1.27 (95% CI 0.93–1.73)
Secondary outcomes
| Outcome | HR (95% CI) | |
|---|---|---|
| First HF hospitalisation or CV death, by baseline MRA use — Empagliflozin vs Placebo · MRA users | 0.58 (0.30–1.11) | |
| First HF hospitalisation or CV death, by baseline MRA use — Empagliflozin vs Placebo · MRA non-users | 0.85 (0.47–1.52) | |
| 0.20.5125Hazard ratio (log scale) |
- First HF hospitalisation or CV death, by baseline MRA use: interaction p = 0.39
Safety
Investigator-reported and severe hyperkalaemia
- Infrequent irrespective of MRA use
- <6%
Original publication
Mineralocorticoid Receptor Antagonist Use and the Effects of Empagliflozin on Clinical Outcomes in Patients Admitted for Acute Heart Failure: Findings from EMPULSE. Eur J Heart Fail. Published 22 August 2023. doi:10.1002/ejhf.2982
Summarised from the published abstract; every number is checked against it