Heart failure & cardiomyopathies
Time from Admission to Randomization and the Effect of Empagliflozin in Acute Heart Failure: A Post-Hoc Analysis from EMPULSE
Authors' conclusion
Among patients hospitalized for acute HF enrolled in EMPULSE, those randomized later after hospital admission (3-5 days) experienced greater clinical benefit with empagliflozin than those randomized earlier (1-2 days).
Study context
- Population
- Patients hospitalized for acute heart failure (HF) enrolled in EMPULSE
- Participants
- 215 vs 312
- Comparison
- Empagliflozin vs placebo, by time from admission to randomization
- 1-2 daysn = 215
- 3-5 daysn = 312
- Primary endpoint
- Hierarchical composite of:
- Time to all-cause death
- Number of HF events
- Time to first HF event
- ≥5-point difference in KCCQ total symptom score change from baseline
- Follow-up
- 90 days
Methodological detailspost-hoc analysis
- Post-hoc analysis
Primary result
As reported in the abstract
Hierarchical composite (empagliflozin vs placebo), by timing subgroup
Empagliflozin vs PlaceboWin ratio (95% CI)
3-5 days
1.69(1.26–2.25)
1-2 days
1.04(0.74–1.44)
Further findings
Clinical event risk, by timing
- Higher risk of clinical events in patients randomized later (3-5 days) than earlier (1-2 days)
HF hospitalization or CV death; all-cause hospitalizations
- Similar pattern (greater empagliflozin benefit with later randomization)
- Interaction p < 0.1 for both
NT-proBNP reduction
- Reduction more pronounced with empagliflozin among patients randomized later than earlier
- Interaction p = 0.004
Original publication
Time from Admission to Randomization and the Effect of Empagliflozin in Acute Heart Failure: A Post-Hoc Analysis from EMPULSE. Eur J Heart Fail. Published 9 July 2024. doi:10.
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