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Breaking News: SGLT2i in ACUTE Heart Failure

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This bite-sized video is a summary of the recent EMPULSE study, that investigated the use of Empagliflozin in people admitted to hospital with acute heart failure.

Well it fills a very important gap in our knowledge we know with stable heart failure of of any type of ejection fraction based on the emperor preserved and emperor reduced studies as well as the uh uh hf studies we know that these drugs uh reduce mortality or improve quality of uh life where if we look at those in the round um but what we don’t know is what

Happens in when people are acutely decompensated and this is where an impulse comes in okay so it’s a randomized control study and these were patients who came in uh acutely unwell uh with acute heart failure um there was uh their entry uh came in on a an anti-pro bmp cut off rather than an echo finding and some clinical features and they were once stabilized and

They were randomized to 10 milligrams of empirical flows in um or placebo on day two through to day five so as all of these studies there’s always a composite outcome and indeed that was positive but the actual individual components of that composite uh were all actually in favor of empigliflozin and that included time to cardiovascular death heart failure events

And the time to heart failure events and quality of life so ambiguous flows in essentially delayed mortality it delayed heart failure events improved quality of life and actually reduce the total number of heart failure events well interesting really and and it builds on some of the evidence we already know so um first of all there was much fewer adverse events

In people taking ampergliphosin rather than placebo i think one thing which caught my eye was acute kidney injury again we saw a reduction in that and we’ve seen that consistently throughout all the sglt2 inhibitor trials and whether you’re looking at people with diabetes people with kidney disease or people with heart failure but because this is the first time

We’re looking at an acutely unwell patient with heart failure acute heart failure decompensated acute heart failure it was i think this is a particularly vulnerable group and it was great to see them benefit from the renal protective effects yeah and and of course diabetic ketoacidosis because this study did have a people living with diabetes as well as people

Who didn’t have diabetes and actually was reassuring there were no cases of diabetic ketoacidosis in terms of what it means to me as a primary care clinician i think if you’ve got someone who’s acutely decompensating i would try to manage them if i can manage them at home i would do so and i would maintain their sglt2 inhibitor and if they’re uh so unwell that

I think they need closer monitoring i would admit them to hospital and hopefully the hospital would continue that medication because we know at by the times of the follow-up of 90 days um those people in the study who uh weren’t on empire flozin actually had uh these excessive adverse events including mortality uh whereas so it does raise the question that if we

Stop these agents in an acute phase are we actually going to do more harm than good so for me that’s the big question just keep going and if they if they’re so unwell that you think they need to be closely monitored well admit them to hospital so they are indeed closely monitored

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Breaking News: SGLT2i in ACUTE Heart Failure By GoggleDocs