From the Guidelines
Empagliflozin has been shown to reduce the risk of heart failure, but its specific effect on atrial fibrillation is not directly stated in the provided evidence, however, based on the available data, it is reasonable to infer that empagliflozin may have a beneficial effect on reducing the risk of atrial fibrillation, particularly in patients with established cardiovascular disease or multiple risk factors. The standard dosing of empagliflozin is typically 10mg or 25mg once daily, taken in the morning, as seen in the EMPEROR-Preserved trial 1. The cardioprotective effects of empagliflozin likely stem from multiple mechanisms including improved hemodynamics through osmotic diuresis, reduced inflammation, decreased epicardial fat, improved left ventricular filling pressures, and reduced fibrosis of cardiac tissue, as discussed in the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1. Some key points to consider when prescribing empagliflozin include:
- Monitoring for side effects such as genital mycotic infections, urinary tract infections, and volume depletion, especially when initiating therapy 1
- The potential for empagliflozin to reduce the risk of heart failure hospitalization and cardiovascular death, as seen in the EMPEROR-Preserved trial 1
- The importance of individualizing treatment strategies for patients with heart failure and atrial fibrillation, as discussed in the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1 It is essential to note that while the evidence suggests a potential benefit of empagliflozin in reducing the risk of atrial fibrillation, the current evidence is not definitive, and more research is needed to fully understand the effects of empagliflozin on atrial fibrillation. However, based on the available data, empagliflozin may be a useful treatment option for patients with established cardiovascular disease or multiple risk factors, and its use should be considered in the context of individual patient needs and medical history 1.
From the Research
Empagliflozin and Atrial Fibrillation Risk
- The relationship between empagliflozin and the risk of atrial fibrillation is complex and has been investigated in several studies 2, 3, 4.
- A study published in the European journal of heart failure in 2020 found that empagliflozin reduced the risk of cardiovascular death or heart failure hospitalization in patients with atrial fibrillation, but did not specifically investigate the risk of developing atrial fibrillation 2.
- In contrast, a real-world observational study published in the Journal of the American Heart Association in 2024 found that dapagliflozin, but not empagliflozin, was associated with a lower risk of incident atrial fibrillation in patients with type 2 diabetes 3.
- A network meta-analysis published in Cureus in 2024 also found that dapagliflozin was more effective than empagliflozin in preventing atrial fibrillation, although both drugs had similar effects on other cardiovascular outcomes 4.
- Other studies have investigated the effects of empagliflozin on cardiovascular risk factors and outcomes, but have not specifically addressed the risk of atrial fibrillation 5, 6.
Key Findings
- Empagliflozin may not have a significant effect on the risk of developing atrial fibrillation, although it can reduce the risk of cardiovascular death or heart failure hospitalization in patients with atrial fibrillation 2, 3, 4.
- Dapagliflozin may be more effective than empagliflozin in preventing atrial fibrillation, although both drugs have similar effects on other cardiovascular outcomes 3, 4.
- The effects of empagliflozin on cardiovascular risk factors and outcomes are complex and may not be fully explained by its effects on individual risk factors 6.