Randomized controlled trials of sodium-glucose cotransporter 2 inhibitors in acute decompensated heart failure
| Trial | Patients | Treatment | Results |
|---|---|---|---|
| EMPULSE3 | N = 530, 67% with left ventricular ejection fraction (LVEF) < 40% | Empagliflozin 10 mg/day or placebo for 90 days, started a median of 3 days after hospital admission | Early benefit, defined by a hierarchical composite that incorporated all-cause mortality, time to heart failure events, and quality of life (measured by Kansas City Cardiomyopathy Questionnaire Total Symptom Score) with empagliflozin use |
| EMPAG-HF4 | N = 59, mean LVEF 45 ± 16% | Empagliflozin 25 mg/day or placebo for 5 days, started within 12 hours of admission | A 25% increase in cumulative urine output over 5 days without affecting markers of renal function with empagliflozin use |
| SOLOIST-WHF8,9 | N = 1,222, 79% with LVEF < 50% | Sotagliflozin 200–400 mg/day or placebo for a median of 9 months, initiated before or shortly after hospital discharge | A 33% reduction of a composite of cardiovascular death and hospitalizations or urgent visits for heart failure and apparent improvement in quality of life as measured by the Kansas City Cardiomyopathy Questionnaire 12 score at 4 months in sotagliflozin group |
| EMPA-RESPONSE-AHF7 | N = 79, 100% with LVEF < 50% | Empagliflozin 10 mg/day or placebo for 30 days, initiated within 24 hours of presentation while on intravenous diuretics | Significantly reduced composite outcome of worsening heart failure, rehospitalization for heart failure, or death at 60 days in empagliflozin group |
| DAPA-RESIST10 | N = 61, 44% with LVEF ≤ 40% | Dapagliflozin 10 mg or metolazone 5–10 mg for up to 3 consecutive days, initiated within 24 hours of trial screening | Significant weight reductions at up to 96 hours of dapagliflozin use compared with metolazone group |
| DICTATE-AHF11 | N = 240, 52% with LVEF < 40% | Dapagliflozin 10 mg/day + protocolized diuretic titration or protocolized diuretic titration alone, initiated within 24 hours of presentation | Strong signal of improved diuretic efficiency (defined as weight change divided by loop diuretic dose) until day 5 of hospitalization or discharge if sooner |
DAPA-RESIST = Dapagliflozin Versus Thiazide Diuretic in Patients With Heart Failure and Diuretic Resistance, DICTATE-AHF = Efficacy and Safety of Dapagliflozin in Acute Heart Failure, EMPAG-HF = Empagliflozin in Acute Decompensated Heart Failure, EMPA-RESPONSE-AHF = Effects of Empagliflozin on Clinical Outcomes in Patients With Acute Decompensated Heart Failure, EMPULSE = Empagliflozin in Patients Hospitalized With Acute Heart Failure Who Have Been Stabilized, SOLOIST-WHF = Effect of Sotagliflozin on Cardiovascular Events in Patients With Type 2 Diabetes Post Worsening Heart Failure