Empagliflozin in heart failure with preserved ejection fraction: first success in mission impossible

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• Heart failure with preserved ejection fraction (HFpEF) is prevalent, with limited effective treatments.
• Current guidelines offer no specific therapy for HFpEF (EF ≥50%) and limited recommendations for mildly reduced EF.
• Existing treatments focus on symptom management, risk factor control, and comorbidity treatment.

Purpose of the Study:

• To review the rationale and findings of the EMPEROR-Preserved trial.
• To discuss the impact of sodium-glucose cotransporter 2 (SGLT2) inhibitors in HFpEF.
• To provide clinical guidance on using SGLT2 inhibitors in heart failure management.

Main Methods:

• The EMPEROR-Preserved trial investigated the efficacy of empagliflozin versus placebo.
• Participants included patients with chronic heart failure and left ventricular ejection fraction (LVEF) >40%.
• Outcomes were assessed across subgroups, including patients with and without diabetes and varying EF levels.

Main Results:

• Empagliflozin demonstrated significantly better outcomes compared to placebo in patients with HFpEF (LVEF >40%).
• These benefits were observed consistently across diverse patient populations, including those with and without diabetes.
• The study provides the first evidence of an effective therapy for HFpEF.

Conclusions:

• Empagliflozin represents a breakthrough in HFpEF treatment, challenging existing therapeutic guidelines.
• SGLT2 inhibitors offer a promising new therapeutic avenue for patients with HFpEF.
• Clinical practice should consider the integration of SGLT2 inhibitors for managing heart failure with preserved ejection fraction.