Can Jardiance (Empagliflozin) be used in patients with diastolic congestive heart failure (CHF) or is it only used in systolic CHF?

Jardiance (Empagliflozin) in Diastolic Heart Failure

Jardiance (empagliflozin) is effective for both diastolic and systolic heart failure, and is now approved for treatment of heart failure regardless of ejection fraction status. 1

Evidence for Empagliflozin in Different Types of Heart Failure

Empagliflozin was initially developed for type 2 diabetes but has demonstrated significant cardiovascular benefits that extend beyond glycemic control:

• The drug has been approved in both the EU and USA for treatment of all adults with symptomatic chronic heart failure, regardless of their left ventricular ejection fraction (LVEF) 1
• In the EMPEROR-Preserved trial, empagliflozin showed significant benefits in patients with heart failure with preserved ejection fraction (HFpEF) or diastolic heart failure (LVEF > 40%) 1
• In the EMPEROR-Reduced trial, empagliflozin demonstrated benefits in patients with heart failure with reduced ejection fraction (HFrEF) or systolic heart failure (LVEF ≤ 40%) 1

Clinical Benefits in Heart Failure

Empagliflozin provides several important benefits for heart failure patients:

• Reduces risk of cardiovascular death or hospitalization for heart failure
• Improves health-related quality of life
• Beneficial effects occur regardless of diabetes status 1
• Produces rapid reductions in pulmonary artery pressures that amplify over time 2
• Improves left ventricular volumes, mass, and systolic function in non-diabetic heart failure patients 3

Dosing Considerations

• Starting dose is typically 10 mg once daily 4
• Some evidence suggests that 25 mg might provide greater improvement in heart function compared to 10 mg in HFrEF patients, with comparable safety profiles 5
• Effects begin as early as week 1 of treatment and increase over time 2

Monitoring and Safety

When using empagliflozin in heart failure patients:

• Monitor renal function, especially in the first several weeks of therapy
• Be alert for potential adverse effects including:
  • Genital mycotic infections
  • Euglycemic diabetic ketoacidosis (rare)
  • Fluid deficits 6
• The drug is generally well-tolerated with an adverse event profile consistent with that seen in patients with T2DM 1

Combination Therapy Considerations

For optimal heart failure management:

• Empagliflozin can be used alongside standard heart failure therapies
• For diastolic heart failure specifically, consider:
  • Beta-blockers to lower heart rate and increase diastolic filling period 7
  • ACE inhibitors which may improve relaxation and cardiac distensibility 7
  • Diuretics when fluid overload is present, but use cautiously to avoid excessive preload reduction 7

Common Pitfalls to Avoid

1. Don't restrict empagliflozin use based on heart failure type (systolic vs. diastolic) - it's effective for both
2. Don't withhold treatment in non-diabetic patients - benefits occur regardless of diabetes status
3. Avoid calcium channel blockers like diltiazem and verapamil in systolic heart failure due to negative inotropic effects 7, though verapamil may be considered in diastolic dysfunction 7
4. Don't overlook the need to monitor renal function, especially early in treatment

Empagliflozin represents an important advancement in heart failure treatment, offering benefits across the spectrum of ejection fractions and regardless of diabetes status.