Empagliflozin and dapagliflozin for improvement of outcome in patients with acute heart failure

Prior treatment

• >1 episode of severe hypoglycaemia within the last 6 months under treatment with insulin or sulfonylurea

Other illness

• History of ketoacidosis
• Acute symptomatic urinary tract infection or genital infection
• Type 1 diabetes
• SGLT-2 Inhibitor at baseline or known allergy to SGLT-2 Inhibitors
• Current active cancer with less than 2 years of life expectancy
• Cardiomyopathy based on infiltrative diseases (e.g. amyloidosis), accumulation diseases (e.g. haemochromatosis, Fabry disease), muscular dystrophies, cardiomyopathy with reversible causes (e.g. stress cardiomyopathy), hypertrophic obstructive cardiomyopathy or known pericardial constriction
• Any severe (obstructive or regurgitant) valvular heart disease, expected to lead to surgery during the trial period

Other

• Pulmonary embolism, cerebrovascular accident as the primary trigger for the current hospitalization
• Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant
• Blood pH<7.32

• Patients 18 years of age with the capacity to provide written informed consent
• eGFR >20 ml/min/1,73m2
• Currently hospitalized for a primary diagnosis of acute/decompensated HF (HFrEF, HFmrEF,HFpEF), including symptoms and signs of fluid overload regardless of ejection fraction or diabetes status
• In patients with HFpEF the diagnosis has to be confirmed according to the current HFpEF definition (by non-invasive testing: evidence of structural or functional changes in the heart as evidenced on echocardiography or by invasive testing as LVEDP assessment or right heart catheterisation).
• Randomized no earlier than 24 hours and up to 10 days after initial presentation while still hospitalized
• Stable as defined by: systolic blood pressure (SBP>100 mmHg for the preceding 6 hours)
• No intensification of IV diuretics within the last 6 hours
• No use of IV vasodilators within the last 6 hours
• No use of IV inotropes or levosimendan within the last 24 hours prior to randomization
• Elevated NT-proBNP >600 pg/mL during the current hospitalization in patients with HFrEF and >300 pg/mL in patients with HFmrEF or HFpEF (or above 900 pg/ml if atrial fibrillation is present at admission independently from EF).