Clinical question: What effect do sodium-glucose cotransporter 2 (SGLT2) inhibitors have on outcomes in adults with heart failure with preserved ejection fraction (HFpEF)?
Background: SGLT2 inhibitors improve clinical outcomes in patients with heart failure with reduced ejection fraction. The effect on patients with HFpEF is unknown.
Study design: Double-blind randomized controlled trial (EMPEROR-Preserved) of 10 mg once-daily empagliflozin or placebo in 5,988 patients with class II-IV heart failure, ejection fraction >40%, and elevated N-terminal-pro hormone B-type natriuretic peptide levels.
Setting: Multicenter international trial in approximately 22 countries enrolling 5,988 patients.
Synopsis: Over a median of 26.2 months, the primary composite outcome of death due to cardiovascular causes or hospitalization for heart failure was reduced from 17.1% in the placebo group to 13.8% in the empagliflozin group (P<0.001), driven mainly by a reduction in heart failure hospitalizations. The effect was similar between those with and without diabetes. Overall serious side effects were similar.
Bottom line: In patients with HFpEF, empagliflozin lowered the combined risk of cardiovascular death or hospitalization for heart failure, independent of the presence of diabetes.
Citation: Anker SD et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021; 385:1451-1461. doi: 10.1056/NEJMoa2107038.
Dr. Anderson is associate professor of medicine, University of Colorado School of Medicine, and executive director, VHA National Hospital Medicine Program hospital medicine section, Rocky Mountain Regional VA Medical Center, Aurora, Colo.