Empagliflozin in Heart Failure with a Preserved Ejection Fraction

Abstract

Over a median of 26.2 months, a primary outcome event occurred in 415 of 2997 patients (13.8%) in the empagliflozin group and in 511 of 2991 patients (17.1%) in the placebo group (hazard ratio, 0.79; 95% confidence interval [CI], 0.69 to 0.90; P<0.001). This effect was mainly related to a lower risk of hospitalization for heart failure in the empagliflozin group. The effects of empagliflozin appeared consistent in patients with or without diabetes. The total number of hospitalizations for heart failure was lower in the empagliflozin group than in the placebo group (407 with empagliflozin and 541 with placebo; hazard ratio, 0.73; 95% CI, 0.61 to 0.88; P<0.001). Uncomplicated genital and urinary tract infections and hypotension were reported more frequently with empagliflozin. CONCLUSIONSEmpagliflozin reduced the combined risk of cardiovascular death or hospitalization for heart failure in patients with heart failure and a preserved ejection fraction, regardless of the presence or absence of diabetes. (Funded by Boehringer Ingelheim and Eli Lilly; EMPEROR-Preserved ClinicalTrials.gov number, NCT03057951).

Contemporary Pillars of Heart Failure with Reduced Ejection Fraction Medical Therapy

“…In this trial, a third of patients had EF between 40% and 50%. This benefit is a promising avenue of treatment for patients with HFmrEF [69]. Dapagliflozin is another SGLT2 inhibitor under investigation for patients with HFpEF in the ongoing DELIVER trial.…”

Left Atrial Myopathy in Heart Failure With Preserved Ejection Fraction

“…with HFrEF. 59 In the Empagliflozin outcome Trial in Patients With Chronic Heart Failure with Preserved Ejection Fraction (EMPEROR-Preserved) trial, 47 the SGLT2i reduced the combined risk of cardiovascular death or HF hospitalization in patients with in HFpEF. Over half the patients participating in the EMPEROR-Preserved trial had a history of AF and, in prespecified subgroup analyses, there was no difference in the efficacy of empagliflozin in patients with or without AF.…”

“…Over half the patients participating in the EMPEROR-Preserved trial had a history of AF and, in prespecified subgroup analyses, there was no difference in the efficacy of empagliflozin in patients with or without AF. 47 Further support for SGLT2i comes from a post hoc analysis of the Multicenter Trial to Evaluate the Effect of Dapagliflozin on the Incidence of Cardiovascular Events (DECLARE-TIMI58) trial, which showed reduced rates of new-onset AF. 60 Other novel pharmacologic approaches also hold promise.…”

Heart Failure in Type 1 Diabetes: A Complication of Concern? A Narrative Review

“…In this line, the EMPA-TROPISM (ATRU-4) study supports the benefit of empagliflozin in the treatment of HF regardless of its glycemic status, by demonstrating significant improvement in the key parameters of cardiac dysfunction, such as left ventricular (LV) volume, LV mass, LV systolic function, functional capacity, and quality of life of non-diabetic HFrEF patients [85]. Finally, results from the EMPEROR-preserve trial have been recently published, showing a reduction of the combined risk of cardiovascular death or hospitalization for HF with 10 mg empagliflozin in patients with HFpEF, regardless of the presence or absence of diabetes [86]. Other molecules of this pharmacological group have also shown benefits concerning cardiovascular mortality and hospitalization for HF (canagliflozin, CANVAS) [87], (sotagliflozin, SOLOIST-WHF) [88] or (ertugliflozin, VERTIS) [89].…”