Empagliflozin: A Review in Symptomatic Chronic Heart Failure

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Empagliflozin, a sodium-glucose cotransporter 2 inhibitor (SGLT2i), is approved for type 2 diabetes mellitus (T2DM).
• Recent approvals in the EU and USA extend empagliflozin's use to symptomatic chronic heart failure (CHF) for all adults, irrespective of left ventricular ejection fraction (LVEF).

Purpose of the Study:

• To evaluate the efficacy and safety of empagliflozin in patients with symptomatic chronic heart failure (CHF) across a spectrum of left ventricular ejection fractions (LVEF).

Main Methods:

• Pivotal Phase III trials (EMPEROR-Preserved and EMPEROR-Reduced) investigated oral empagliflozin 10 mg/day added to standard care in ambulant patients with symptomatic CHF.
• These trials included patients with mildly-reduced or preserved ejection fraction (LVEF > 40%) and those with reduced ejection fraction (LVEF ≤ 40%).
• Outcomes assessed included the composite of cardiovascular death or hospitalization for heart failure (HHF), other worsening HF events, health-related quality of life (HRQOL), and safety.

Main Results:

• Empagliflozin significantly reduced the risk of cardiovascular death or HHF in patients with symptomatic CHF, regardless of LVEF.
• The benefits were observed irrespective of the presence of type 2 diabetes mellitus (T2DM) and background heart failure therapies.
• Empagliflozin also significantly improved HRQOL and demonstrated a generally well-tolerated safety profile consistent with its use in T2DM.

Conclusions:

• Empagliflozin is a valuable treatment option for ambulant patients with symptomatic CHF across a broad LVEF spectrum.
• The drug offers significant cardiovascular and quality-of-life benefits in heart failure patients.
• Its efficacy in CHF is independent of diabetes status, broadening its therapeutic application.