When is Jardiance (Empagliflozin) used in heart failure?

From the Guidelines

Jardiance (empagliflozin) is recommended for patients with heart failure, including those with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF), as it reduces the risk of cardiovascular death and hospitalization for heart failure, as shown in the EMPEROR-Preserved trial 1. The medication works by inhibiting sodium-glucose cotransporter-2 (SGLT2) in the kidneys, which increases glucose excretion in urine and reduces cardiac preload and afterload. Some key points to consider when using Jardiance in heart failure patients include:

• The standard dose is 10 mg once daily, taken orally, and it can be used in addition to standard heart failure therapies such as ACE inhibitors, ARBs, beta-blockers, and mineralocorticoid receptor antagonists.
• Jardiance is particularly beneficial for patients with an ejection fraction of 40% or less, as it reduces the risk of cardiovascular death and hospitalization for heart failure.
• Patients should be monitored for potential side effects including genital mycotic infections, urinary tract infections, and volume depletion.
• Jardiance should be used cautiously in patients with severe renal impairment (eGFR <30 mL/min/1.73m²) and is not recommended for those with type 1 diabetes due to increased risk of diabetic ketoacidosis, as stated in the 2024 ESC guidelines for the management of chronic coronary syndromes 1. The benefits of Jardiance in heart failure patients have been consistently shown across multiple studies, including the EMPEROR-Preserved trial, which demonstrated a significant reduction in the primary composite endpoint of time to HF hospitalization or cardiovascular death, driven mostly by a significant reduction in time to HF hospitalization 1.

From the Research

Use of Jiardiance (Empagliflozin) in Heart Failure

• Empagliflozin is used in the treatment of heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) 2, 3, 4, 5.
• The EMPEROR-Preserved trial showed that empagliflozin reduces the risk of cardiovascular death or hospitalization for heart failure in patients with HFpEF, regardless of the presence or absence of diabetes 2.
• A pre-specified analysis of the EMPEROR-Preserved trial found that empagliflozin reduces the risk of cardiovascular death or hospitalization for heart failure in patients with HFpEF with and without atrial fibrillation 3.
• The EMPA-REG OUTCOME trial found that empagliflozin's treatment effect was consistent in predicted HFpEF, HFmrEF/HFrEF, and no-HF for each outcome 5.
• A post-hoc analysis of the EMPEROR-Reduced trial found that the efficacy of empagliflozin on the primary outcome was consistent regardless of background diuretic therapy 6.

Efficacy of Empagliflozin in Different Patient Populations

• Empagliflozin reduces the risk of cardiovascular death or hospitalization for heart failure in patients with HFrEF and HFpEF 2, 4.
• Empagliflozin's efficacy is consistent in patients with HFpEF with and without atrial fibrillation 3.
• Empagliflozin's treatment effect is consistent in predicted HFpEF, HFmrEF/HFrEF, and no-HF for each outcome 5.
• The efficacy of empagliflozin is consistent regardless of background diuretic therapy 6.

Safety Profile of Empagliflozin

• The safety profile of empagliflozin is unaffected by baseline diuretic dose 6.
• Uncomplicated genital and urinary tract infections and hypotension were reported more frequently with empagliflozin 2.
• The total rates of adverse events were higher among patients with higher baseline doses of diuretic agents, independently of treatment allocation 6.