Empagliflozin has broad beneficial effect on HFpEF outcomes
medwireNews: Empagliflozin treatment produces significant reductions in the risk for a broad range of inpatient and outpatient heart failure (HF) outcomes in people with a preserved ejection fraction (pEF), shows further analysis of EMPEROR-Preserved.
In the primary analysis, the 2997 study participants randomly assigned to take daily empagliflozin 10 mg had a 21% lower risk for heart failure hospitalization or cardiovascular death relative to the 2991 people taking placebo.
In this extended analysis, the risk reduction was 27% for total (first and recurrent) HF hospitalizations, 16% for total cardiovascular hospitalizations, and a nonsignificant 7% for hospital admission for any reason.
“This decline is expected whenever hospitalizations that are not particularly influenced by a treatment are added in a stepwise manner to the analysis of events in a trial of patients with heart failure and a preserved ejection fraction, in whom only 46% of the hospital admissions are related to a cardiovascular reason and only 18% are related to worsening heart failure,” say Milton Packer (Baylor Heart and Vascular Institute, Dallas, Texas, USA) and study co-authors.
The effect of empagliflozin on the risk for total HF hospitalization was evident across all subgroups, although it was less strong for people with an ejection fraction of 60% or greater.
“These findings are concordant with our yet-to-be-published observations that the effect of empagliflozin to reduce the risk of heart failure hospitalization is similar in magnitude across a broad range of ejection fractions ranging from <25% to <65% but appears to be attenuated in patients with an ejection fraction of 65% or greater,” say the researchers.
Empagliflozin treatment also significantly reduced hospitalizations requiring intravenous diuretics, vasopressor or positive inotropic drugs, or intensive care. In addition to which, active treatment significantly reduced participants’ likelihood of requiring outpatient intensification of diuretics.
“The lower risk of hospital admissions did not result in a longer length of stay when patients in the empagliflozin group were hospitalized for heart failure,” observe the study authors in Circulation.
Furthermore, by the week 12 study visit, participants taking empagliflozin were a significant 23% more likely than those taking placebo to be in a better New York Heart Association functional class, and this benefit persisted throughout the 148-week study.
“An early symptom effect is concordant with our finding on clinical events,” say the researchers, adding that it is also consistent with findings in patients with reduced ejection fraction.
The findings were also presented at the virtual ESC Congress 2021.
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