Abstract 14084: Empagliflozin in Hospitalized Patients With Heart Failure

Abstract

Introduction: The sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recommended as part of guideline-directed medication therapy (GDMT) for those with heart failure (HF) and New York Heart Associated (NYHA) class II-IV symptoms. The 2022 AHA/ACC/HFSA HF guidelines recommend SGLT2i in those with HF and reduced ejection fraction (HFrEF), and to consider in those with mid-range or preserved ejection fraction (HFmrEF and HFpEF). Hypothesis: We aimed to evaluate the initiation of empagliflozin in patients hospitalized with HF to prove tolerability over other GDMT and continuation at discharge. Methods: This was a multi-center, retrospective review of empagliflozin initiation at 2 campuses of the same health system (NYU Langone Hospital-Long Island and NYU Langone Health) from November 2021 -October 2022. We included patients > 18 years of age with HF that received empagliflozin during hospitalization. Data collection included patient characteristics, empagliflozin dose, ejection fraction (EF), BNP, estimated glomerular filtration rate, and other GDMT including beta-blockers (BB), angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), angiotensin receptor/neprilysin inhibitor (ARNI), and mineralocorticoid receptor antagonists (MRA). The primary outcome was empagliflozin initiation per EF. Secondary outcomes included evaluation of GDMT and continuation of therapies at discharge. Results: In total 434 medical records were reviewed, with 244 patients continued empagliflozin from home and 190 new initiations. When evaluated by EF, 73% of empagliflozin initiation occurred in patients with HFrEF, 22% in HFpEF and 5% in HFmrEF. The median age was 68 years (60-78), with a median BMI of 28 (24-34), and 64% were male. Concomitant GDMT included BB in 56%, ACEi/ARB in 33%, ARNI in 12%, MRA in 14% and loop diuretics in 48% of patients. The majority of these patients (87%) were able to continue empagliflozin at discharge. Out of the 13% that did not continue empagliflozin, the most common reason for discontinuation was lack of insurance coverage. Conclusions: Empagliflozin was safely initiated in patients hospitalized with a HF exacerbation and led to greater tolerability over other GDMT at hospital discharge.