Heart failure & cardiomyopathiesSecondary analysis
Heart Failure Outcomes and Empagliflozin Effects in Patients with Heart Failure and Reduced Ejection Fraction in Sinus Rhythm or Atrial Fibrillation: Data from EMPEROR-Reduced
- Post-hoc analysis of the EMPEROR-Reduced randomised trial
- subgroup analysis
Authors' conclusion
In HFrEF, AF did not significantly modify outcomes after adjustment and did not associate with eGFR slopes. Empagliflozin reduced outcomes, eGFR decline and improved QoL regardless of AF or SR and probably reduced incident AF.
Study context
- Population
- Patients with heart failure with reduced ejection fraction (HFrEF) in EMPEROR-Reduced with available rhythm analyses (missing or paced rhythms excluded)
- Participants
- 2,785 patients
- Comparison
- Empagliflozin vs placebo, by atrial fibrillation (AF) vs sinus rhythm
- AFn = 928
- Sinus rhythm (SR)n = 1,857reference
Primary result
As reported in the abstract
CV death or HHF, empagliflozin vs placebo, by rhythm · median follow-up 20 months
Empagliflozin vs PlaceboHazard ratio (95% CI)
AF
0.82(0.63–1.08)
SR
0.69(0.56–0.84)
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Incident AF · numerically lower, not significant | 0.66 (0.40–1.09) | P = 0.11 | |
| 0.512Hazard ratio (log scale) |
Outcomes by AF vs SR (prognostic)
- No significant difference AF vs SR for primary endpoint
- P = 0.66
- No significant difference AF vs SR for first hospitalization for heart failure (HHF)
- P = 0.19
- No significant difference AF vs SR for recurrent HHF
- P = 0.45
Time to first HHF, empagliflozin vs placebo by rhythm
- Consistent effect in AF and SR
- interaction p = 0.20
First and recurrent HHF, empagliflozin vs placebo by rhythm
- Borderline but insignificant interaction
- P = 0.10
Annual estimated glomerular filtration rate (eGFR) decline and quality of life (QoL) scores by rhythm
- Effect not different between AF and SR
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Heart Failure Outcomes and Empagliflozin Effects in Patients with Heart Failure and Reduced Ejection Fraction in Sinus Rhythm or Atrial Fibrillation: Data from EMPEROR-Reduced. Eur J Heart Fail. Published 16 September 2025. doi:10.1002/ejhf.70021
Summarised from the published abstract; every number is checked against it