Diastolic heart failure is the spectre of cardiology. To date, there is no conclusive therapy concept that improves the poor prognosis of those affected. Many hopeful treatment approaches were investigated and had to be discarded. That could now change with the results of the EMPEROR-preserved study. Positive results were achieved for the first time.
Diastolic heart failure (HFpEF) occurs with similar frequency and is as serious a condition as systolic heart failure (HFrEF). However, no drug treatment exists yet that can improve the prognosis in the long term. In patients with reduced ejection fraction, SGLT2 inhibitors can now be used successfully to reduce hospitalizations for heart failure. On this basis, the EMPEROR-Preserved study investigated whether empagliflozin is also effective in heart failure patients with preserved ejection fraction.
This study ranks third among large heart failure trials of this SGLT2 inhibitor. The first was EMPA-REG OUTCOME in type 2 diabetes patients, which demonstrated significant reductions in serious cardiovascular events (cardiovascular death, myocardial infarction, or stroke) as well as cardiovascular-related death and heart failure hospitalizations. The second trial was EMPEROR-Reduced, which demonstrated that empagliflozin was effective in heart failure with reduced ejection fraction regardless of the presence of diabetes. Now the data in patients with diastolic heart failure have been presented.
Combined endpoint achieved significantly less frequently
5988 patients with class II-IV heart failure and an ejection fraction greater than 40% received either 10 mg empagliflozin or placebo once daily in addition to standard baseline therapy. The primary end point was the composite of cardiovascular death and hospitalization for heart failure. After a median follow-up of 26.2 months, significantly fewer patients in the SGLT2 inhibitor group had reached endpoint than in the placebo group (13.8% vs. 17.1%). This corresponds to a risk reduction of 21%. This effect was mainly due to a lower risk of hospitalization for heart failure in the empagliflozin group.
The benefit extended across all subgroups, regardless of left ventricular ejection fraction (LVEF), diabetes status, or patient gender. No new safety signals occurred with an overall good safety profile.
Congress: ESC digital 2021
CARDIOVASC 2021; 20(3): 38 (published 8/9/21, ahead of print).
HAUSARZT PRAXIS 2021; 16(9): 44
