Impact of early administration of empagliflozin in patients with acute decompensated heart failure on medium-term prognosis (3 and 6 months)

Aim. To evaluate the impact of early administration of empagliflozin — from the first day of treatment of acute decompensated heart failure (ADHF) on outcomes at 3 and 6 months.
Material and methods. The study included 92 patients admitted to the hospital with ADHF without hemodynamic instability. On the 1st day of hospitalisation, patients were included in the study and were randomized to receive empagliflozin at a daily dose of 10 and 25 mg (in case of ineffective glycemic control for patients with type 2 diabetes mellitus) into two equal groups. The patients in the comparison group received treatment without gliflozines during the hospital period of the study, however, upon discharge from the hospital, empagliflozin or dapagliflozin was recommended along with other prescriptions, while 8 patients started taking this class of drug.: 7 — within 3 months after discharge from the hospital, 1 — during the 3rd — 6th month of the study. Data on the development of adverse cardiovascular events and surgical interventions for cardiovascular diseases, as well as side effects and adverse events associated with empagliflozin therapy were collected from all participants at each stage of inpatient and outpatient follow-up (3 and 6 months after discharge from the hospital).
Results. Of the 92 study participants, there were 18 (19,6%) deaths (all due to ADHF) and 9 (9,8%) nonfatal cardiovascular events over the 6-month period. Over the entire observation period, a lower number of all cases of adverse cardiovascular events were observed in the empagliflozin group (26,1% vs 76,1%, p <0,001). Kaplan-Meier analysis showed significant differences in survival, as well as in the time to any adverse event (death or nonfatal event), depending on the use of empagliflozin within 6 months after the ADHF episode: 6,5% vs 32,6% (p=0,002) and 15,2% vs 43,5% (p=0,003), respectively. When analyzing the outcomes in individual study periods (day of discharge — month 3; months 3 — 6), the frequency of adverse events was significantly lower in the main group (13,3% vs 48,8%, p=0,001; 8,9% vs 32,4%, p=0,009, respectively), and a difference was noted in the frequency of fatal outcomes at month 3 (0% vs 20,9%) and non-fatal events at month 6 (0% vs 14,7%) depending on the intake of empagliflozin. No adverse reactions or undesirable effects were registered during therapy.
Conclusion. Treatment of patients with ADHF with empagliflozin at a dose of 10 mg/day from the first day of hospitalisation is safe and improves the prognosis (mortality and recurrent ADHF episodes) at 3 and 6 months after hospital discharge.

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