The Curbsiders Internal Medicine Podcast #393 Live from SHM: Clinical Updates in Hospital Medicine
May 1, 2023
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Inpatient SGLT2s Improve Symptoms
- The EMPULSE trial started empagliflozin during acute heart failure hospitalization and measured a composite clinical benefit at 90 days.
- The treatment improved symptoms and diuretic responsiveness driving a 36% higher win ratio for benefit.
Augment Loop Diuretics With Acetazolamide
- Add IV acetazolamide to loop diuretics to augment decongestion when following a standardized diuresis protocol.
- The ADVOR trial showed a 12% absolute increase in patients achieving clinical decongestion by day three (NNT≈8).
Be Proactive With Diuretic Augmentation
- Consider diuretic augmentation (metolazone or similar) early when diuresis slows; evidence supports safety and symptomatic benefit.
- Use trials like ADVOR and EMPULSE to justify escalation in non–diuretic-resistant patients.