Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal, ehac320. https://doi.org/10.1093/eurheartj/ehac320 Dr. Wolfram Doehner et al
Points
- The trial’s purpose was to evaluate the efficacy and safety of using empagliflozin for patients with symptomatic heart failure with reduced ejection fraction, regardless of diabetes status.
- The EMPEROR-reduced trial revealed that empagliflozin is better than placebo for improving heart failure symptoms in patients with symptomatic stability HfrEF on baseline GDMT regardless of diabetes status.
- Asians and people of North America showed more influence than white or Europeans concerning baseline characteristics like HF hospitalization/ cardiovascular death or the effect of empagliflozin.
- Although sodium-glucose cotransporter II inhibitor was used as a management drug for type-II diabetes, the EMPA-REG trial showed clear benefits for HF treatment.
Summary
This study was carried out to check the efficacy of empagliflozin in heart failure patients. For this purpose sample of 1863 patients for empagliflozin dosage and 1867 for placebo treatment was randomized. Inclusion criteria were decided as the patient having ≥ 18 years of age with chronic heart failure had left ventricular ejection fraction (LVEF) and was hospitalized within 12 months. White and Asian categories were included from New York Heart Association (NYHA) functional class II (75%)/III/IV having type-II diabetes (50%), mean LVEF (27%), estimated glomerular filtration rate < 60 (48%), ICD (31%), and CRT (12%). The primary findings showed reduced cardiovascular death and HF hospitalization in empagliflozin than placebo. The secondary results were a reduction in the composite renal outcome, all-cause mortality, and new onset of diabetes in prediabetic patients.
There was a reduction in systolic blood pressure, death/emergency HF visit/HF hospitalization, which required intravenous treatment, and intensification of diuretics. Kansas City Cardiomyopathy Questionnaire-Clinical Summary (KCCQ-CS) mean score was noted in the early 3 months and remained sustained over 12 months. The primary endpoint in patients with recent volume overload in empagliflozin was 28.4% and in placebo was 24.8%, but without volume overload, it was 16.0% in empagliflozin and 22.2% in placebo. No differences were noted for the endpoint of HF hospitalizations, intensification of diuretics, systolic blood pressure, NT-proBNP, or body weight in patients due to with or without the recent volume and use of MRA for empagliflozin vs. placebo. Empagliflozin reduces renal replacement therapy and initiation of potassium binders. The use of empagliflozin also reduced the risk of hyperuricemia by 32%.
Link to the article: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehac320/6631286
References Doehner, W., Anker, S. D., Butler, J., Zannad, F., Filippatos, G., Ferreira, J. P., Salsali, A., Kaempfer, C., Brueckmann, M., Pocock, S. J., Januzzi, J. L., & Packer, M. (2022). Uric acid and sodium-glucose cotransporter-2 inhibition with empagliflozin in heart failure with reduced ejection fraction: The EMPEROR-reduced trial. European Heart Journal, ehac320. https://doi.org/10.1093/eurheartj/ehac320
