EMPULSE Response Predictor (Empagliflozin in Heart Failure)

EMPULSE Response Predictor (Empagliflozin in Heart Failure): Explanation and Clinical Context The EMPULSE Response Predictor estimates the likelihood of a favorable clinical outcome with empagliflozin in patients hospitalized for acute heart failure, based on findings from the EMPULSE trial. The trial demonstrated that empagliflozin, initiated in-hospital (median 3 days post-admission), led to significantly higher rates of clinical benefit at 90 days compared to placebo, across the spectrum of ejection fraction and irrespective of diabetes status. This predictor incorporates key baseline variables associated with empagliflozin response: systolic blood pressure, renal function (eGFR), congestion severity, NT-proBNP level, heart failure phenotype (HFrEF vs HFpEF), age, and diabetes status.

A higher predicted probability reflects clinical characteristics similar to those associated with positive outcomes in the trial — namely preserved or midrange EF, higher SBP, mild-to-moderate congestion, and adequate renal function. Clinical Significance In EMPULSE, empagliflozin improved the composite endpoint of all-cause death, number of heart failure events, time to first heart failure event, and ≥5-point improvement in KCCQ total symptom score. Benefits were observed early, were consistent across EF subgroups, and were independent of background diuretic or guideline-directed medical therapy.

Clinical Interpretation Summary A high predicted probability (>70%) suggests a strong likelihood of early and sustained improvement in heart failure status, reduced risk of rehospitalization, and improved patient-reported outcomes. Patients with severe congestion, very low blood pressure, or impaired renal function may still benefit but require closer monitoring and stepwise initiation.