Empagliflozin effects in patients with heart failure

Sodium-glucose co-transporter 2 (SGLT2) inhibitors have shown reduction in hospitalisation for heart failure (HHF) and serious adverse renal events risks, beyond their glucose-lowering benefits. More specifically, patients with type 2 diabetes who received SGLT2 inhibitors in large-scale, randomised, placebo-controlled trials experienced a 30% to 35% lower risk of HHF compared with patients who received placebo, even though most of them did not have a history of heart failure at baseline.

In this publication the authors report the results of the Empagliflozin Outcome Trial in Patients with Chronic Heart Failure and a Reduced Ejection Fraction (EMPEROR-Reduced) which evaluated the effects of empagliflozin in 3730 patients (with or without diabetes) with Class II, III or IV heart failure and a reduced ejection fraction of 40% or less. Patients were randomised to receive the SGLT2i empagliflozin (10 mg once daily) or placebo, in addition to recommended therapy.

Overall, empagliflozin favourably influenced the composite primary outcome of cardiovascular deaths or hospitalisation for worsening of heart failure with a hazard ratio of 0.75 (95% CI, 0.65-0.86, P<0.001) regardless of the presence or absence of diabetes. The combined relative risk reduction of 25% for the primary composite endpoint was primarily related to a 31% lower risk of HHF (HR 0.69, 95% CI 0.59-0.81).