Heart failure & cardiomyopathies
Safety and Efficacy of Empagliflozin and Diuretic Use in Patients with Heart Failure and Preserved Ejection Fraction: A Post Hoc Analysis of the EMPEROR-Preserved Trial
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
Methodological detailsphase 3, double-blind, placebo-controlled, subgroup analysis by baseline diuretic use and dose
- Phase 3
- Double-blind
- Placebo-controlled
- Subgroup analysis by baseline diuretic use and dose
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 escalationEmpagliflozinvs Placebo | 0.74 (0.65–0.84) | |
| Diuretic dose de-escalationEmpagliflozinvs Placebo | 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)Empagliflozinvs PlaceboPatients 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: A Post Hoc Analysis of the EMPEROR-Preserved Trial. JAMA Cardiol. Published 1 July 2023. doi:10.
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