Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure
- PMID: 32865377
- DOI: 10.1056/NEJMoa2022190
Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure
Abstract
Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of hospitalization for heart failure in patients regardless of the presence or absence of diabetes. More evidence is needed regarding the effects of these drugs in patients across the broad spectrum of heart failure, including those with a markedly reduced ejection fraction.
Methods: In this double-blind trial, we randomly assigned 3730 patients with class II, III, or IV heart failure and an ejection fraction of 40% or less to receive empagliflozin (10 mg once daily) or placebo, in addition to recommended therapy. The primary outcome was a composite of cardiovascular death or hospitalization for worsening heart failure.
Results: During a median of 16 months, a primary outcome event occurred in 361 of 1863 patients (19.4%) in the empagliflozin group and in 462 of 1867 patients (24.7%) in the placebo group (hazard ratio for cardiovascular death or hospitalization for heart failure, 0.75; 95% confidence interval [CI], 0.65 to 0.86; P<0.001). The effect of empagliflozin on the primary outcome was consistent in patients regardless of the presence or absence of diabetes. The total number of hospitalizations for heart failure was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.70; 95% CI, 0.58 to 0.85; P<0.001). The annual rate of decline in the estimated glomerular filtration rate was slower in the empagliflozin group than in the placebo group (-0.55 vs. -2.28 ml per minute per 1.73 m2 of body-surface area per year, P<0.001), and empagliflozin-treated patients had a lower risk of serious renal outcomes. Uncomplicated genital tract infection was reported more frequently with empagliflozin.
Conclusions: Among patients receiving recommended therapy for heart failure, those in the empagliflozin group had a lower risk of cardiovascular death or hospitalization for heart failure than those in the placebo group, regardless of the presence or absence of diabetes. (Funded by Boehringer Ingelheim and Eli Lilly; EMPEROR-Reduced ClinicalTrials.gov number, NCT03057977.).
Copyright © 2020 Massachusetts Medical Society.
Comment in
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More Evidence for SGLT2 Inhibitors in Heart Failure.N Engl J Med. 2020 Oct 8;383(15):1481-1482. doi: 10.1056/NEJMe2027915. Epub 2020 Aug 28. N Engl J Med. 2020. PMID: 32865378 No abstract available.
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Empagliflozin improves outcomes in HFrEF regardless of diabetic status.Nat Rev Cardiol. 2020 Nov;17(11):681. doi: 10.1038/s41569-020-00455-7. Nat Rev Cardiol. 2020. PMID: 32929192 No abstract available.
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EMPEROR-Reduced supports the use of SGLT2 inhibitors for the treatment of patients with heart failure and reduced ejection fraction: Comment on the EMPEROR-Reduced trial.Eur Heart J. 2020 Oct 21;41(40):3881-3882. doi: 10.1093/eurheartj/ehaa783. Eur Heart J. 2020. PMID: 33026074 No abstract available.
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More reasons to use SGLT2 inhibitors: EMPEROR-reduced and DAPA-CKD.Kidney Int. 2020 Dec;98(6):1387-1389. doi: 10.1016/j.kint.2020.10.002. Epub 2020 Oct 14. Kidney Int. 2020. PMID: 33068607 No abstract available.
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Organ protection beyond glycaemic control with SGLT2 inhibitors.Nat Rev Nephrol. 2021 Apr;17(4):223-224. doi: 10.1038/s41581-020-00373-4. Nat Rev Nephrol. 2021. PMID: 33159190 No abstract available.
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In heart failure, adding empagliflozin to medical therapy reduced a composite of CV death or HF hospitalization.Ann Intern Med. 2020 Nov 17;173(10):JC51. doi: 10.7326/ACPJ202011170-051. Ann Intern Med. 2020. PMID: 33197352
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Empagliflozin in Heart Failure.N Engl J Med. 2021 Jan 28;384(4):384-385. doi: 10.1056/NEJMc2033669. N Engl J Med. 2021. PMID: 33503353 No abstract available.
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Empagliflozin in Heart Failure.N Engl J Med. 2021 Jan 28;384(4):385. doi: 10.1056/NEJMc2033669. N Engl J Med. 2021. PMID: 33503354 No abstract available.
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Empagliflozin in Heart Failure.N Engl J Med. 2021 Jan 28;384(4):385-386. doi: 10.1056/NEJMc2033669. N Engl J Med. 2021. PMID: 33503355 No abstract available.
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Empagliflozin in Heart Failure.N Engl J Med. 2021 Jan 28;384(4):386. doi: 10.1056/NEJMc2033669. N Engl J Med. 2021. PMID: 33503356 No abstract available.
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Empagliflozin in Heart Failure.N Engl J Med. 2021 Jan 28;384(4):386-387. doi: 10.1056/NEJMc2033669. N Engl J Med. 2021. PMID: 33503357 No abstract available.
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Empagliflozin in Heart Failure.N Engl J Med. 2021 Jan 28;384(4):387. doi: 10.1056/NEJMc2033669. N Engl J Med. 2021. PMID: 33503358 No abstract available.
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Empagliflozin bei Herzschwäche zugelassen.MMW Fortschr Med. 2021 Sep;163(15):62. doi: 10.1007/s15006-021-0181-4. MMW Fortschr Med. 2021. PMID: 34478094 German. No abstract available.
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Cannabisblüten-Vollextrakt aus Dänemark.MMW Fortschr Med. 2021 Sep;163(15):62. doi: 10.1007/s15006-021-0324-7. MMW Fortschr Med. 2021. PMID: 34478095 German. No abstract available.
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Therapie steht auf vier Säulen.MMW Fortschr Med. 2021 Dec;163(21-22):78. doi: 10.1007/s15006-021-0616-y. MMW Fortschr Med. 2021. PMID: 34888815 German. No abstract available.
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The use of sodium-glucose cotransporter 2 inhibitor in heart failure: The rise of the Roman Empire!Natl Med J India. 2021 Nov-Dec;34(6):347-350. doi: 10.25259/NMJI_922_21. Natl Med J India. 2021. PMID: 35818099 No abstract available.
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