From the Guidelines
Jardiance (empagliflozin) can be used in patients with heart failure with reduced ejection fraction (HFrEF), with a recommended dose of 10 mg once daily. According to the most recent guidelines, including the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1, empagliflozin is now recommended as part of standard therapy for patients with HFrEF. The EMPEROR-Reduced trial demonstrated a reduction in HF hospitalization/CV death from empagliflozin treatment in patients with HFrEF with and without diabetes 1.
When starting Jardiance in heart failure patients, no dose adjustment is needed based on kidney function, though it's not recommended for patients with severe renal impairment (eGFR less than 20 mL/min/1.73m²) 1. Patients should be advised about potential side effects including genital mycotic infections, urinary tract infections, and volume depletion. They should maintain adequate hydration and be monitored for hypotension, especially if they're taking diuretics. Empagliflozin works as an SGLT2 inhibitor, which promotes glucose excretion in urine, but its benefits in heart failure appear to extend beyond glycemic control through mechanisms including improved cardiac energetics, reduced cardiac fibrosis, and beneficial hemodynamic effects.
Key points to consider when using Jardiance in patients with HFrEF include:
- Monitoring for potential side effects
- Maintaining adequate hydration
- Monitoring for hypotension, especially in patients taking diuretics
- Avoiding use in patients with severe renal impairment
- Using the recommended dose of 10 mg once daily, as outlined in the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1 and the 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment 1.
From the Research
Indications for Jardiance (Empagliflozin)
- Jardiance (empagliflozin) is approved for the treatment of heart failure with reduced ejection fraction (HFrEF) in adults, regardless of the presence of type 2 diabetes mellitus (T2DM) 2.
- Empagliflozin has been shown to reduce the risk of cardiovascular death or hospitalization for heart failure in patients with HFrEF, as demonstrated in the EMPEROR-Reduced trial 2, 3.
- The efficacy and safety of empagliflozin in improving cardiovascular and renal outcomes in HFrEF have been consistently shown across different age groups, including older patients (aged ≥75) 3.
Efficacy in HFrEF
- Empagliflozin has been found to improve left ventricular ejection fraction and reduce the ratio of New York Heart Association functional class III or IV, left ventricular end-diastolic diameter, and N-terminal pro-B-type natriuretic peptide in patients with HFrEF 4.
- The addition of empagliflozin to background therapy has been shown to reduce the risk of cardiovascular death and heart failure hospitalization in patients with HFrEF, regardless of background therapy or its target doses 5.