Portal de investigação
Mineralocorticoid receptor antagonist use and the effects of empagliflozin on clinical outcomes in patients admitted for acute heart failure: Findings from EMPULSE
Data de publicação:
Data Ahead of Print:
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 In patients hospitalized for acute heart failure (AHF) empagliflozin produced greater clinical benefit than placebo. Many patients with AHF are treated with mineralocorticoid receptor antagonists (MRAs). The interplay between empagliflozin and MRAs in AHF is yet to be explored. This study aimed to evaluate the efficacy and safety of empagliflozin versus placebo according to MRA use at baseline in the EMPULSE trial (NCT04157751) Methods and results In this analysis all comparisons were performed between empagliflozin and placebo, stratified by baseline MRA use. The primary outcome included all-cause death, heart failure events, and a =5 point difference in Kansas City Cardiomyopathy Questionnaire (KCCQ) total symptom score at 90 days, assessed using the win ratio (WR). First heart failure hospitalization or cardiovascular death was a secondary outcome. From the 530 patients randomized, 276 (52%) were receiving MRAs at baseline. MRA users were younger, had lower ejection fraction, better renal function, and higher KCCQ scores. The primary outcome showed benefit of empagliflozin irrespective of baseline MRA use (WR 1.46, 95% confidence interval [CI] 1.08- 1.97 and WR1.27, 95% CI 0.93- 1.73 in MRA users and non-users, respectively; interaction p= 0.52). The effect of empagliflozin on first heart failure hospitalization or cardiovascular death was not modified by MRA use (hazard ratio [HR] 0.58, 95% CI 0.30- 1.11 and HR 0.85, 95% CI 0.47- 1.52 in MRA users and non-users, respectively; interaction p= 0.39). Investigator-reported and severe hyperkalaemia events were infrequent (<6%) irrespective of MRA use. Conclusions In patients admitted for AHF, initiation of empagliflozin produced clinical benefit and was well tolerated irrespective of background MRA use. These findings support the early use of empagliflozin on top of MRA therapy in patients admitted for AHF. [GRAPHICS] .
Dados da publicação
- ISSN/ISSNe:
- 1388-9842, 1879-0844
- Tipo:
- Article
- Páginas:
- 1797-1805
- DOI:
- 10.1002/ejhf.2982
- Link para outro recurso:
- www.scopus.com
European Journal of Heart Failure Wiley-Blackwell
Citações Recebidas na Web of Science: 1
Citações Recebidas na Scopus: 7
Documentos
- Não há documentos
Filiações
Keywords
- Empagliflozin; Acute heart failure; Mineralocorticoid receptor antagonists
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
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. 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. 2023. 25. (10):p. 1797-1805. IF:18,200. (1).
