Efficacy of Empagliflozin in Heart Failure with Preserved versus Mid-range Ejection Fraction: a Pre-specified Analysis of EMPEROR-Preserved
Nat Med. 2022;28:2512–2520 DOI: 10.1038/s41591-022-02041-5
Results from EMPEROR-Preserved demonstrated that empagliflozin improved CV death and HF hospitalisation – the primary outcome – in patients with HF and LVEF >40%. This pre-specified analysis of EMPEROR-Preserved aimed to evaluate the effect of empagliflozin in patients with HFpEF (LVEF ≥50%) compared with patients who had HFmrEF (LVEF 41–49%).
Empagliflozin vs placebo reduced the risk of the primary outcome by 17% in patients with LVEF ≥50% and by 29% in patients with LVEF 41–49%, without a significant difference between the two LVEF subgroups (P=0.27). The benefit was largely driven by a reduction in hospitalisations for HF in both subgroups. Empagliflozin slowed the decline in eGFR to a similar extent in patients with LVEF ≥50% and those with LVEF 41–49%.
These results, together with those from EMPEROR-Reduced in patients with LVEF <40%, support the use of empagliflozin in HF across the full spectrum of LVEF.