Do SGLT2 inhibitors help in heart failure with preserved ejection fraction (HFpEF)?
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].
- 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.
Empagliflozin in Heart Failure with a Preserved Ejection Fraction (EMPEROR-Preserved)
Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (DELIVER)
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