From the Guidelines
Jardiance (empagliflozin) is recommended for the treatment of heart failure, including both heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), regardless of whether the patient has diabetes, due to its proven benefits in reducing the risk of worsening heart failure and cardiovascular death, as demonstrated in the EMPEROR-Reduced trial 1. The typical dose for heart failure is 10 mg once daily, taken in the morning with or without food. Jardiance works by inhibiting sodium-glucose cotransporter-2 (SGLT2) in the kidneys, which increases glucose excretion in urine and reduces sodium reabsorption. This leads to beneficial effects for heart failure patients including reduced cardiac workload, decreased blood pressure, improved cardiac metabolism, and reduced cardiac fibrosis. Some key points to consider when prescribing Jardiance for heart failure include:
- The medication has been shown to reduce the risk of hospitalization for heart failure by 21% in the EMPEROR-Reduced trial 1
- The effects of empagliflozin were consistent in people with or without diabetes 1
- Patients should be aware of potential side effects including genital yeast infections, urinary tract infections, and volume depletion
- It's essential to maintain adequate hydration while taking Jardiance and to temporarily stop the medication during periods of reduced oral intake or significant illness
- Patients with severe kidney impairment (eGFR less than 20 mL/min/1.73m²) should not use Jardiance, and regular monitoring of kidney function is recommended while on this medication. The most recent and highest quality study, EMPEROR-Reduced 1, demonstrated the benefits of empagliflozin in the treatment of heart failure, and its findings are consistent with those of other studies, such as DAPA-HF and DELIVER 1.
From the FDA Drug Label
JARDIANCE is a prescription medicine used to: reduce the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure, when the heart cannot pump enough blood to the rest of your body.
The primary endpoint was the time to first event of either cardiovascular (CV) death or hospitalization for heart failure (HHF). JARDIANCE was superior in reducing the risk of the primary composite endpoint of cardiovascular death or hospitalization for heart failure compared with placebo, mostly through a reduction in hospitalization for heart failure.
The role of Jardiance (Empagliflozin) in the treatment of heart failure is to reduce the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure.
- Key benefits:
- Reduces the risk of cardiovascular death
- Reduces the risk of hospitalization for heart failure
- Study results: JARDIANCE was superior in reducing the risk of the primary composite endpoint of cardiovascular death or hospitalization for heart failure compared with placebo, mostly through a reduction in hospitalization for heart failure 2.
From the Research
Role of Jardiance (Empagliflozin) in Heart Failure Treatment
- Empagliflozin has been shown to reduce the risk of heart failure hospitalization and cardiovascular death in patients with type 2 diabetes and high cardiovascular risk 3, 4, 5.
- The EMPA-REG OUTCOME trial demonstrated that empagliflozin reduced the risk of heart failure hospitalization or cardiovascular death by 34% compared to placebo 3.
- Empagliflozin has also been shown to improve other heart failure outcomes, including hospitalization for or death from heart failure, and reduce the risk of all-cause hospitalization 3.
- The beneficial effects of empagliflozin on heart failure outcomes have been observed across a range of baseline subgroups, including patients with and without baseline heart failure 3, 5.
Mechanism of Action
- The exact mechanism of empagliflozin's beneficial effects on heart failure outcomes is not fully understood, but it is thought to be related to its diuretic effect and ability to reduce cardiovascular risk factors 4, 6.
- Empagliflozin has been shown to reduce blood pressure, body weight, and visceral adiposity, which may contribute to its beneficial effects on heart failure outcomes 5.
Clinical Evidence
- Several clinical trials have demonstrated the efficacy and safety of empagliflozin in patients with heart failure and type 2 diabetes mellitus, including the EMPEROR-Preserved and EMPEROR-Reduced trials 7.
- Empagliflozin has been approved for the treatment of symptomatic chronic heart failure in adults, regardless of their left ventricular ejection fraction (LVEF) 7.
- The clinical evidence suggests that empagliflozin is a valuable treatment option for patients with heart failure and type 2 diabetes mellitus, and may be used in combination with other heart failure therapies 7, 5.