# Do SGLT2 inhibitors help in heart failure with preserved ejection fraction (HFpEF)?

Canonical page: https://cliniatlas.com/evidence/sglt2-inhibitors-heart-failure-preserved-ejection-fraction-hfpef/

**Summary:** Yes — they reduce heart-failure hospitalisation across the preserved/mildly-reduced EF range; mortality benefit is not established.

SGLT2 inhibitors reduce heart-failure hospitalisation in patients with heart failure and preserved (or mildly reduced) ejection fraction. In EMPEROR-Preserved (empagliflozin, ~6,000 patients, LVEF >40%), the primary composite of cardiovascular death or hospitalisation for heart failure fell significantly, driven mainly by fewer heart-failure hospitalisations [1].

DELIVER (dapagliflozin, ~6,300 patients, LVEF >40%) confirmed a similar reduction in the composite of worsening heart failure or cardiovascular death, supporting a class effect across this population [2]. Benefit was broadly consistent regardless of diabetes status.

Neither trial demonstrated a clear reduction in cardiovascular or all-cause mortality; the benefit is chiefly on heart-failure events. Treatment is generally well tolerated, with attention needed for volume status and genital infections [1, 2].

## Limitations

- The mortality benefit in HFpEF is not established; benefit is predominantly on hospitalisation/worsening-HF outcomes.
- "Preserved" was defined as LVEF >40%, so results include mildly reduced ejection fraction.

## Sources

1. [IV / Randomised trial] Empagliflozin in Heart Failure with a Preserved Ejection Fraction (EMPEROR-Preserved). New England Journal of Medicine (2021). PMID 34449189. https://pubmed.ncbi.nlm.nih.gov/34449189/
2. [IV / Randomised trial] Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (DELIVER). New England Journal of Medicine (2022). PMID 36027570. https://pubmed.ncbi.nlm.nih.gov/36027570/

Ask this question against live sources (free, no sign-in): https://cliniatlas.com/?q=Do%20SGLT2%20inhibitors%20help%20in%20heart%20failure%20with%20preserved%20ejection%20fraction%20(HFpEF)%3F

---

CliniAtlas is an EU-hosted clinical evidence search platform for verified
healthcare professionals, built in Split, Croatia, with the University of
Split School of Medicine. Free for verified clinicians and students:
https://cliniatlas.com/

For literature search, education, and professional evidence review only.
Not for diagnosis, treatment selection, triage, monitoring, prognosis, or
patient-specific clinical decision-making.