Portal de investigação
Time from admission to randomization and the effect of empagliflozin in acute heart failure: A post-hoc analysis from EMPULSE
Autores da FMUP
Participantes de fora da FMUP
- Blatchford, JP
- Teerlink, JR
- Kosiborod, MN
- Angermann, CE
- Biegus, J
- Collins, SP
- Tromp, J
- Nassif, ME
- Psotka, MA
- Comin-Colet, J
- Mentz, RJ
- Brueckmann, M
- Nordaby, M
- Ponikowski, P
- Voors, AA
Unidades de investigação
Abstract
Aims Patients hospitalized for acute heart failure (HF) could be enrolled in EMPULSE (NCT04157751) upon haemodynamic stabilization and between 24 h and 5 days after hospital admission. The timing of treatment initiation may influence the efficacy and safety of drugs such as empagliflozin. The aim of this study was to evaluate patient characteristics, clinical events, and treatment effects according to time from admission to randomization. Methods and results The EMPULSE population was dichotomized by median time from hospital admission to randomization (1-2 days vs. 3-5 days). The primary outcome was a hierarchical composite endpoint of time to all-cause death, number of HF events, time to first HF event, and a >= 5-point difference in Kansas City Cardiomyopathy Questionnaire total symptom score change from baseline after 90 days, analysed using the win ratio (WR) method. Patients randomized later (3-5 days, average time 3.9 days; n = 312) had a higher risk of experiencing clinical events than patients randomized earlier (1-2 days, average time 1.7 days; n = 215). The treatment effect favoured empagliflozin versus placebo in patients randomized later (3-5 days: WR 1.69, 95% confidence interval [CI] 1.26-2.25) but was attenuated in patients randomized earlier (1-2 days: WR 1.04, 95% CI 0.74-1.44) (interaction p = 0.029). A similar pattern was observed for the composite of HF hospitalization or cardiovascular death and all-cause hospitalizations (interaction p < 0.1 for both). The reduction of N-terminal pro-B-type natriuretic peptide levels was more pronounced with empagliflozin among patients randomized later than in patients randomized earlier (interaction p = 0.004). Conclusions 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). These findings should be confirmed in future studies before clinical application.
Dados da publicação
- ISSN/ISSNe:
- 1388-9842, 1879-0844
- Tipo:
- Article
- Páginas:
- 1976-1983
- DOI:
- 10.1002/ejhf.3369
- Link para outro recurso:
- www.scopus.com
European Journal of Heart Failure Wiley-Blackwell
Citações Recebidas na Web of Science: 2
Citações Recebidas na Scopus: 3
Documentos
- Não há documentos
Filiações
Keywords
- Acute heart failure; Empagliflozin; Timing of randomization
Financiamento
Proyectos asociados
Dapagliflozin, Spironolactone or Both for HFpEF (SOGALDI-PEF) - NCT05676684
Investigador Principal: João Pedro Melo Marques Pinho Ferreira
Ensaio Clínico Académico (SOGALDI-PEF) . AstraZeneca . 2022
Initiation of ARNi and SGLT2i in Patients With HFrEF: Randomized Open-label Trial (INITIATE-HFrEF) -NCT05989503
Investigador Principal: João Pedro Melo Marques Pinho Ferreira
Ensaio Clínico Académico (INITIATE-HFrEF) . Novartis . 2023
Citar a publicação
Ferreira JP,Blatchford JP,Teerlink JR,Kosiborod MN,Angermann CE,Biegus J,Collins SP,Tromp J,Nassif ME,Psotka MA,Comin J,Mentz RJ,Brueckmann M,Nordaby M,Ponikowski P,Voors AA. Time from admission to randomization and the effect of empagliflozin in acute heart failure: A post-hoc analysis from EMPULSE. Eur. J. Heart Fail. 2024. 26. (9):p. 1976-1983. IF:18,200. (1).
