Abstract：
BACKGROUND: This study aims to compare the addition of SGLT2 inhibitors or doubling the diuretic dose in patients receiving treatment with beta-blockers, angiotensin-converting enzyme inhibitors (ACEi), or angiotensin receptor blockers (ARB), as well as mineralocorticoid receptor antagonists (MRA), for heart failure with reduced ejection fraction (HFrEF) who present to the emergency department with decompensated heart failure.
METHODS: This study is a single-center and prospective analysis. A total of 980 decompensated heart failure (HFrEF) patients receiving optimal medical therapy (OMT) according to the 2021 European heart failure guidelines were randomized in a 2:1 ratio into the furosemide and empagliflozin treatment arms. The analysis includes patient clinical characteristics, laboratory results, and echocardiographic data. Factors influencing rehospitalization were identified through multivariate Cox regression analysis. Log-rank analysis was employed to assess factors affecting rehospitalization.
RESULTS: The mean age of the patients was 67.9 years, with 52.1% being men. There was no significant impact of demographic, clinical, or echocardiographic factors on rehospitalization at 1 month; only the effect of treatment subgroups on rehospitalization was observed (p = 0.039). Significant echocardiographic and clinical improvements were seen in both treatment arms. The empagliflozin group exhibited significant improvements in 6-min walk distance, heart rate, body weight, NT-pro BNP levels, and eGFR level compared to the furosemide group. The rate of rehospitalization in the first month was significantly lower in those receiving empagliflozin (28.7%) compared to those receiving a double dose of furosemide (40.2%) (log-rank p = 0.013).
CONCLUSIONS: This study provides valuable insights into the management of decompensated HFrEF and demonstrates that SGLT2 inhibitors offer benefits beyond glycemic control in this patient group. The significant reduction in rehospitalization rates and improvements in echocardiographic parameters underscore the potential of SGLT2 inhibitors in reducing acute heart failure episodes.
METHODS: This study is a single-center and prospective analysis. A total of 980 decompensated heart failure (HFrEF) patients receiving optimal medical therapy (OMT) according to the 2021 European heart failure guidelines were randomized in a 2:1 ratio into the furosemide and empagliflozin treatment arms. The analysis includes patient clinical characteristics, laboratory results, and echocardiographic data. Factors influencing rehospitalization were identified through multivariate Cox regression analysis. Log-rank analysis was employed to assess factors affecting rehospitalization.
RESULTS: The mean age of the patients was 67.9 years, with 52.1% being men. There was no significant impact of demographic, clinical, or echocardiographic factors on rehospitalization at 1 month; only the effect of treatment subgroups on rehospitalization was observed (p = 0.039). Significant echocardiographic and clinical improvements were seen in both treatment arms. The empagliflozin group exhibited significant improvements in 6-min walk distance, heart rate, body weight, NT-pro BNP levels, and eGFR level compared to the furosemide group. The rate of rehospitalization in the first month was significantly lower in those receiving empagliflozin (28.7%) compared to those receiving a double dose of furosemide (40.2%) (log-rank p = 0.013).
CONCLUSIONS: This study provides valuable insights into the management of decompensated HFrEF and demonstrates that SGLT2 inhibitors offer benefits beyond glycemic control in this patient group. The significant reduction in rehospitalization rates and improvements in echocardiographic parameters underscore the potential of SGLT2 inhibitors in reducing acute heart failure episodes.
摘要：
背景：本研究旨在比较接受β受体阻滞剂治疗的患者中添加SGLT2抑制剂或将利尿剂剂量加倍的情况，血管紧张素转换酶抑制剂（ACEi），或血管紧张素受体阻滞剂（ARB），以及盐皮质激素受体拮抗剂（MRA），对于出现失代偿性心力衰竭的急诊部门的射血分数降低（HFrEF）的心力衰竭。
方法：本研究是单中心和前瞻性分析。根据2021年欧洲心力衰竭指南，共有980例失代偿性心力衰竭（HFrEF）患者接受最佳药物治疗（OMT），以2：1的比例随机分配到呋塞米和依帕列净治疗组中。分析包括患者的临床特征，实验室结果,和超声心动图数据.通过多因素Cox回归分析确定影响再住院的因素。采用Log-rank分析评估影响再住院的因素。
结果：患者的平均年龄为67.9岁，52.1%是男性。人口没有显著影响，临床,或1个月时再住院的超声心动图因素;仅观察到治疗亚组对再住院的影响(p=0.039).在两个治疗组中都看到了明显的超声心动图和临床改善。empagliflozin组显示显著改善6分钟步行距离，心率,体重,NT-proBNP水平，和eGFR水平与呋塞米组相比。与接受双倍剂量呋塞米（40.2％）的患者相比，接受依帕列净（28.7％）的患者在第一个月的再住院率明显较低（log-rankp=0.013）。
结论：本研究为失代偿HFrEF的管理提供了有价值的见解，并证明SGLT2抑制剂在该患者组中提供了超越血糖控制的益处。再住院率的显著降低和超声心动图参数的改善强调了SGLT2抑制剂在减少急性心力衰竭发作方面的潜力。
方法：本研究是单中心和前瞻性分析。根据2021年欧洲心力衰竭指南，共有980例失代偿性心力衰竭（HFrEF）患者接受最佳药物治疗（OMT），以2：1的比例随机分配到呋塞米和依帕列净治疗组中。分析包括患者的临床特征，实验室结果,和超声心动图数据.通过多因素Cox回归分析确定影响再住院的因素。采用Log-rank分析评估影响再住院的因素。
结果：患者的平均年龄为67.9岁，52.1%是男性。人口没有显著影响，临床,或1个月时再住院的超声心动图因素;仅观察到治疗亚组对再住院的影响(p=0.039).在两个治疗组中都看到了明显的超声心动图和临床改善。empagliflozin组显示显著改善6分钟步行距离，心率,体重,NT-proBNP水平，和eGFR水平与呋塞米组相比。与接受双倍剂量呋塞米（40.2％）的患者相比，接受依帕列净（28.7％）的患者在第一个月的再住院率明显较低（log-rankp=0.013）。
结论：本研究为失代偿HFrEF的管理提供了有价值的见解，并证明SGLT2抑制剂在该患者组中提供了超越血糖控制的益处。再住院率的显著降低和超声心动图参数的改善强调了SGLT2抑制剂在减少急性心力衰竭发作方面的潜力。
