Heart failure & cardiomyopathiesSecondary analysis
Safety and Efficacy of Empagliflozin and Diuretic Use in Patients with Heart Failure and Preserved Ejection Fraction
- Post hoc analysis of the EMPEROR-Preserved randomised trial
- phase 3
- double-blind
- placebo-controlled
- subgroup analysis by baseline diuretic use and dose
Authors' conclusion
In this study, treatment with empagliflozin was similar regardless of diuretic use or dose. Empagliflozin use was associated with decreased conventional diuretic dosing.
Study context
- Population
- Patients with class II–IV HF and LVEF >40% (heart failure and preserved ejection fraction (HFpEF)) in EMPEROR-Preservedof 5988 enrolled
- Participants
- 5,815 patients
- Comparison
- Empagliflozin vs placebo by baseline diuretic status and dose
- No diureticn = 1,179
- <40 mgn = 1,725
- 40 mgn = 1,772
- >40 mgn = 1,139
- Primary endpoint
- First hospitalization for HF (HHF) or CV death and its components
Primary result
As reported in the abstract
HHF or CV death, by baseline diuretic status
Empagliflozin vs PlaceboHazard ratio (95% CI)
diuretic subgroup
0.81(0.70–0.93)
nondiuretic subgroup
0.72(0.48–1.06)
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Diuretic dose escalation | 0.74 (0.65–0.84) | |
| Diuretic dose de-escalation | 1.15 (1.02–1.30) | |
| 0.512Hazard ratio (log scale) |
First hospitalization for heart failure (HHF), total HHF, eGFR decline rate, KCCQ-23 clinical summary score, by diuretic status
- Diuretic status not associated with changes in improvements with empagliflozin
Outcomes by diuretic dose in placebo
- Higher diuretic doses had worse outcomes in placebo
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| Volume depletion (patients taking diuretics) · patients taking diuretics | 1.34 (1.13–1.59) | |
| 0.512Hazard ratio (log scale) |
Original publication
Safety and Efficacy of Empagliflozin and Diuretic Use in Patients with Heart Failure and Preserved Ejection Fraction. JAMA Cardiol. Published 1 July 2023. doi:10.1001/jamacardio.2023.1090
Summarised from the published abstract; every number is checked against it