TY - JOUR
TI - Effect of Empagliflozin on Worsening Heart Failure Events in Patients
With Heart Failure and Preserved Ejection Fraction EMPEROR-Preserved
Trial
AU - Packer, Milton
AU - Butler, Javed
AU - Zannad, Faiez
AU - Filippatos,
AU - Gerasimos
AU - Ferreira, Joao Pedro
AU - Pocock, Stuart J.
AU - Carson,
AU - Peter
AU - Anand, Inder
AU - Doehner, Wolfram
AU - Haass, Markus and
AU - Komajda, Michel
AU - Miller, Alan
AU - Pehrson, Steen
AU - Teerlink, John
AU - R.
AU - Schnaidt, Sven
AU - Zeller, Cordula
AU - Schnee, Janet M. and
AU - Anker, Stefan D.
AU - EMPEROR-Preserved Trial Study Grp
JO - CIRCULATION
PY - 2021
VL - 144
TODO - 16
SP - 1284-1294
PB - Lippincott, Williams & Wilkins
SN - 0009-7322
TODO - 10.1161/CIRCULATIONAHA.121.056824
TODO - heart failure; sodium-glucose transporter 2 inhibitors
TODO - BACKGROUND: Empagliflozin reduces the risk of cardiovascular death or
hospitalization for heart failure in patients with heart failure with
preserved ejection fraction, but additional data are needed about its
effect on inpatient and outpatient heart failure events.
METHODS: We randomly assigned 5988 patients with class II through IV
heart failure with an ejection fraction of >40% to double-blind
treatment with placebo or empagliflozin (10 mg once daily), in addition
to usual therapy, for a median of 26 months. We prospectively collected
information on inpatient and outpatient events reflecting worsening
heart failure and prespecified their analysis in individual and
composite end points.
RESULTS: Empagliflozin reduced the combined risk of cardiovascular
death, hospitalization for heart failure, or an emergency or urgent
heart failure visit requiring intravenous treatment (432 versus 546
patients [empagliflozin versus placebo, respectively]; hazard ratio,
0.77 [95% CI, 0.67-0.87]; P<0.0001). This benefit reached statistical
significance at 18 days after randomization. Empagliflozin reduced the
total number of heart failure hospitalizations that required intensive
care (hazard ratio, 0.71 [95% CI, 0.52-0.96]; P=0.028) and the total
number of all hospitalizations that required a vasopressor or positive
inotropic drug (hazard ratio, 0.73 [95% CI, 0.55-0.97]; P=0.033).
Compared with patients in the placebo group, fewer patients in the
empagliflozin group reported outpatient intensification of diuretics
(482 versus 610; hazard ratio, 0.76 [95% CI, 0.67-0.86]; P<0.0001),
and patients assigned to empagliflozin were 20% to 50% more likely to
have a better New York Heart Association functional class, with
significant effects at 12 weeks that were maintained for at least 2
years. The benefit on total heart failure hospitalizations was similar
in patients with an ejection fraction of >40% to <50% and 50% to
<60%, but was attenuated at higher ejection fractions.
CONCLUSIONS: In patients with heart failure with preserved ejection
fraction, empagliflozin produced a meaningful, early, and sustained
reduction in the risk and severity of a broad range of inpatient and
outpatient worsening heart failure events.
ER -