Jardiance (Empagliflozin) for Heart Failure in Non-Diabetic Patients
Yes, Jardiance (empagliflozin) is strongly recommended for heart failure treatment regardless of diabetes status, as it reduces hospitalization for heart failure and cardiovascular mortality across the entire spectrum of ejection fractions. 1
Evidence Supporting Empagliflozin Use in Non-Diabetic Heart Failure Patients
Clinical Trial Evidence
- The EMPEROR-Preserved trial demonstrated that empagliflozin 10 mg daily reduced the primary composite outcome of cardiovascular death or hospitalization for heart failure by 21% (HR 0.79 [95% CI 0.69–0.90]; P < 0.001) over a median of 26.2 months 2, 3
- Importantly, the effects of empagliflozin were consistent in people with or without diabetes 2, 4
- In EMPEROR-Reduced trial, empagliflozin showed benefits in heart failure with reduced ejection fraction that were also independent of diabetes status 5
Guideline Recommendations
- Both American College of Cardiology and European Society of Cardiology strongly recommend SGLT2 inhibitors (including empagliflozin) as first-line therapy for heart failure across all ejection fraction ranges, regardless of diabetes status 1
- Empagliflozin is part of quadruple first-line therapy for heart failure with reduced ejection fraction (HFrEF) alongside ACE inhibitor/ARB/ARNI, beta-blocker, and mineralocorticoid receptor antagonist 1
- For heart failure with preserved ejection fraction (HFpEF), empagliflozin is recommended as first-line therapy regardless of diabetes status 1
Dosing and Implementation
- The recommended dose for heart failure is empagliflozin 10 mg once daily 1
- Can be initiated during hospitalization for heart failure after patient stabilization 1
- For patients with eGFR ≥30 mL/min/1.73m², empagliflozin is appropriate 1
- For patients with eGFR 20-30 mL/min/1.73m², dapagliflozin remains the only SGLT2 inhibitor option 1
Clinical Benefits in Non-Diabetic Heart Failure Patients
- Reduced risk of hospitalization for heart failure 2, 3
- Reduced cardiovascular death 2
- Reduced total number of heart failure hospitalizations 5, 3
- Improved New York Heart Association (NYHA) functional class 5
- Benefits observed early after initiation (as early as 12-28 days) and sustained during long-term follow-up 5
Mechanism of Action in Heart Failure
Empagliflozin provides cardiovascular benefits through multiple mechanisms, including:
- Reduction in preload and afterload
- Decreased myocardial oxygen demand
- Improved cardiac metabolism
- Reduced cardiac fibrosis
- Natriuretic and diuretic effects without activating the sympathetic nervous system 1
Monitoring and Safety Considerations
- Key monitoring needs include:
- Genital mycotic infections
- Urinary tract infections
- Volume depletion/hypotension
- Rare but serious risk of euglycemic diabetic ketoacidosis (though less relevant in non-diabetic patients) 1
- Studies show no increased risk of hypoglycemic events in non-diabetic patients compared to placebo 4
Conclusion
The evidence strongly supports using empagliflozin 10 mg daily for heart failure treatment in patients without diabetes. The medication reduces hospitalization for heart failure and cardiovascular mortality with a favorable safety profile, and should be considered a standard component of heart failure management regardless of diabetes status.