Role of Empagliflozin in Heart Failure Management

Efficacy and Benefits

Empagliflozin is strongly recommended for all patients with symptomatic chronic heart failure regardless of ejection fraction or diabetes status, as it significantly reduces cardiovascular mortality, heart failure hospitalizations, and improves quality of life, according to the American Diabetes Association 1, 2
The American Heart Association recommends empagliflozin as it reduces the risk of hospitalization for heart failure by 35% compared to placebo in patients with type 2 diabetes and high cardiovascular risk 3, 1
Benefits of empagliflozin are consistent across heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) populations, as stated by the European Society of Cardiology 1, 4
In patients with HFrEF (LVEF ≤40%), empagliflozin reduced the composite outcome of cardiovascular death or hospitalization for heart failure by 21% (HR 0.79 [95% CI 0.69–0.90]; P < 0.001), as reported by the American College of Cardiology 2
Empagliflozin reduces the same composite outcome by 21% in patients with HFpEF (LVEF >40%), according to the Heart Failure Society of America 3, 4
The American Diabetes Association notes that benefits of empagliflozin are observed regardless of diabetes status, with similar efficacy in patients with and without diabetes 1

The American Diabetes Association recommends monitoring for symptomatic hypotension, particularly in patients with renal impairment, elderly patients, those with low systolic blood pressure, or patients on diuretics, and also notes the risk of diabetic ketoacidosis exists, including euglycemic ketoacidosis, requiring monitoring especially in susceptible patients 5

The American Heart Association considers empagliflozin for all patients with symptomatic heart failure (NYHA class II-IV) regardless of ejection fraction or diabetes status, and recommends assessing for signs/symptoms of ketoacidosis, particularly during illness or fasting 1, 2, 5

The American Heart Association, American College of Cardiology, and Heart Failure Society of America recommend empagliflozin 10 mg once daily for all patients with symptomatic heart failure, regardless of ejection fraction, diabetes status, or renal function, as it significantly reduces cardiovascular death and heart failure hospitalizations while improving quality of life 6

The 2022 AHA/ACC/HFSA guidelines provide a Class 2a recommendation for SGLT2 inhibitors in HFmrEF to decrease heart failure hospitalizations and cardiovascular mortality 6
In the EMPEROR-Preserved subgroup with LVEF 41-49%, empagliflozin reduced the primary composite endpoint without significant interaction by ejection fraction subgroups 6
Patients with LVEF on the lower end of the HFmrEF spectrum respond similarly to HFrEF patients and should be treated accordingly 6

Empagliflozin significantly reduces the slope of eGFR decline across all stages of renal function 6

Empagliflozin results in modest but significant improvements in quality of life scores at 52 weeks 6