Key result
Empagliflozin cuts CV death or HF hospitalization ~23% vs placebo regardless of prior event timing.
Why the study?
Patients with a recent HF hospitalization face high rehospitalization and mortality risks, and the effect of empagliflozin according to the timing of prior HF hospitalization was not established.
Does empagliflozin reduce the composite of heart failure hospitalization or cardiovascular death in heart failure patients across different categories of prior hospitalization recency?
RCT (n=9,718)
Double-blind
1:1
Yes
Does empagliflozin reduce the composite of heart failure hospitalization or cardiovascular death in heart failure patients across different categories of prior hospitalization recency?
Effect estimate: HR 0.77 (95% CI 0.70-0.84)
Absolute Event Rate: 16% vs 20%
Empagliflozin provides consistent relative risk reduction for cardiovascular death or heart failure hospitalization regardless of the recency of prior heart failure hospitalization, with greater absolute benefits observed in those with more recent hospitalizations.
Prioritizes empagliflozin after recent HF hospitalization for larger absolute benefit; confirms consistent relative efficacy across recency categories.
BACKGROUND: Patients with a recent heart failure (HF) hospitalization have a high risk of rehospitalization and mortality. Early treatment may have a substantial impact on patient outcomes. OBJECTIVES: This study sought to study the outcomes and effect of empagliflozin according to timing of prior HF hospitalization. METHODS: EMPEROR-Pooled (EMPEROR-Reduced [EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction] and EMPEROR-Preserved [EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction] combined) included 9,718 HF patients who were grouped according to the recency of HF hospitalization (none, <3 months, 3-6 months, 6-12 months, >12 months). The primary outcome was a composite of time to first of HF hospitalization or cardiovascular death, over a median follow-up of 21 months. RESULTS: The primary outcome event rates (per 100 person-years) in the placebo group were 26.7, 18.1, 13.7, and 2.8 for patients hospitalized within 3 months, 3-6 months, 6-12 months, and >12 months, respectively. The relative risk reduction of primary outcome events with empagliflozin was similar across HF hospitalization categories (P interaction = 0.67). The primary outcome absolute risk reduction was more pronounced among patients with a recent HF hospitalization but without statistical heterogeneity of treatment effect: -6.9, -5.5, -0.8, and -0.6 events prevented per 100 person-years for patients hospitalized within <3 months, 3-6 months, 6-12 months, and >12 months, respectively, and -2.4 events prevented per 100 person-years of follow-up in those without a prior HF hospitalization (P interaction = 0.64). Empagliflozin was safe irrespective of HF hospitalization recency. CONCLUSIONS: Patients with a recent HF hospitalization have a high risk of events. Empagliflozin reduced HF events regardless of HF hospitalization recency.
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Ferreira et al. (2023) conducted an RCT in Chronic heart failure (n=9,718). Empagliflozin vs. Placebo was evaluated on Composite of time to first heart failure hospitalization or cardiovascular death (HR 0.77, 95% CI 0.70-0.84). Empagliflozin reduced the risk of cardiovascular death or heart failure hospitalization by 23% compared to placebo, with consistent relative benefits regardless of the recency of prior heart failure hospitalization.
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