Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 80(1), 1–18. https://doi.org/10.1016/j.jacc.2022.04.040 Dr. Michael Böhm et al
Points
- Patients (n = 5,988) were grouped according to baseline age and were examined for the influence of age on the effects of empagliflozin on CVD or HFH as a primary outcome
- The incidence of primary outcomes increased with age in the placebo group; meanwhile, empagliflozin reduced primary outcomes
- Empagliflozin was found to reduce primary outcomes across a broad age range
Summary
While it is known that empagliflozin plays a vital role in reducing cardiovascular death (CVD) or heart failure (HF) hospitalization (HFH) in HF and preserved ejection fraction patients, its treatment effects and age-related safety concerns have yet to be studied in depth. Thus, the relationships surrounding the factors of age and empagliflozin effects were studied from the perspective of EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction).
5,988 patients were grouped according to their baseline age (<65 years [n = 1,199], 65-74 years [n = 2,214], 75-79 years [n = 1,276], ≥80 years [n = 1,299]); from there, the influence of age on the effects of empagliflozin on CVD or HFH were determined as a primary outcome. Secondary outcomes included the following: total HFH, rate of decline in estimated glomerular filtration rate, health-related quality of life (QoL) with the Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score (KCCQ-CSS), and the frequency of adverse effects.
Primary outcomes incidence (P trend = 0.02) and CVD (P trend = 0.003) were found to increase with age when considering patients under placebo. Meanwhile, empagliflozin managed to reduce primary outcomes (P trend = 0.33), first HFH (P trend = 0.22), and first and recurrent HFH (P trend = 0.11) with respect to all age groups; this effect was found to be similar at ≥75 years (P interaction = 0.22) or >80 years (P interaction = 0.51). Improvements were also seen for the KCCQ-CSS at around week 52 in the empagliflozin group, which also attenuated the decline of the estimated glomerular filtration rate without age interaction (P = 0.48 and P = 0.32, respectively). Overall, no differences in adverse events between the empagliflozin and placebo groups were observed across age groups.
In summary, empagliflozin reduced primary outcomes and first and recurrent HFH and improved symptoms across a broad age range. Relatively old age, meanwhile, was not found to be associated with reduced efficacy or meaningful intolerability.
Link to the article: https://www.sciencedirect.com/science/article/pii/S0735109722049373
References Böhm, M., Butler, J., Filippatos, G., Ferreira, J. P., Pocock, S. J., Abdin, A., Mahfoud, F., Brueckmann, M., Gollop, N. D., Iwata, T., Ponikowski, P., Wanner, C., Zannad, F., Packer, M., & Anker, S. D. (2022). Empagliflozin improves outcomes in patients with heart failure and preserved ejection fraction irrespective of age. Journal of the American College of Cardiology, 80(1), 1–18. https://doi.org/10.1016/j.jacc.2022.04.040
