Starting gliflozin early in the emergency room for older adults with worsening heart failure

Who can take part

• Male or female, age ≥ 75 years
• Admitted to the emergency department for acute decompensated heart failure, diagnosed by the emergency physician based on a range of factors including: (i) Worsening symptoms of chronic heart failure - worsening dyspnea or dyspnea at rest - progressive asthenia - weight gain - worsening of edema/abdominal distension/anasarca (ii) AND objective signs or diagnostic tests consistent with peripheral and/or pulmonary congestion - jugular venous distension - bilateral crackles on pulmonary auscultation - presence of S3 gallop on cardiac auscultation - ascites - hepatomegaly - peripheral edema - radiological and/or ultrasound signs of pulmonary congestion - dilatation of the inferior vena cava (iii) AND elevated natriuretic peptides (BNP or NT-proBNP): a. For patients in sinus rhythm: BNP ≥ 400 pg/mL or NT-proBNP ≥ 1,600 pg/mL b. For patients with atrial fibrillation: BNP ≥ 600 pg/mL or NT-proBNP ≥ 2,400 pg/mL) (iv) AND need for treatment intensification upon admission (increased doses of oral diuretics, addition of a second diuretic, or initiation of intravenous diuretic therapy)
• Patients considered for hospitalization
• No pre-existing treatment with gliflozins (empagliflozin or dapagliflozin)
• Signed and dated informed consent

Who cannot take part

• Presence of acute coronary syndrome on ECG or within 30 days prior to randomization,
• Percutaneous or surgical coronary intervention planned or performed within 30 days prior to randomization,
• Type 1 diabetes,
• Any other medical condition that would put the patient at risk or could influence the results of the study,
• Chronic kidney disease (glomerular filtration rate < 25 ml/min/1.73 m²),
• Any severe valvular heart disease that may require surgery during the study
• Known intolerance or history of hypersensitivity to the active substance or any of the excipients in the medication
• Persons subject to legal protection measures, psychiatric care, persons admitted to a health or social care facility,
• Individuals unable to express consent, follow instructions, or comply with follow-up procedures,
• Not affiliated with or not a beneficiary of a French social security system,
• Subject is in the exclusion period of another study or listed in the “national volunteer registry.”
• The patient is finally referred and admitted to the Cardiology Department
• The patient is ultimately referred to return home or to a residential care facility for dependent elderly people
• Cardiogenic shock,
• Persons deprived of liberty,