When is Empagliflozin (Jardiance) added according to the New York Heart Association (NYHA) classification?

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Last updated: March 24, 2025View editorial policy

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From the Guidelines

Jardiance (empagliflozin) is recommended for patients with New York Heart Association (NYHA) Class II, III, or IV heart failure with an ejection fraction of 40% or less, regardless of diabetes status, to reduce the risk of cardiovascular death and hospitalization for heart failure. The EMPEROR-Reduced trial 1 demonstrated a 21% reduction in the primary composite outcome of cardiovascular death or hospitalization for worsening heart failure in patients with NYHA Class II, III, or IV heart failure and an ejection fraction of 40% or less, with approximately 50% of subjects having type 2 diabetes at baseline. The standard dosing of empagliflozin is 10 mg once daily, which can be taken with or without food.

Key benefits of empagliflozin include:

  • Reduced risk of cardiovascular death and hospitalization for heart failure
  • Improved cardiac energetics, reduced cardiac preload and afterload, and anti-inflammatory effects
  • Favorable effects in patients with or without diabetes

Important considerations when prescribing empagliflozin include:

  • Monitoring for potential side effects such as genital mycotic infections, urinary tract infections, and volume depletion
  • Assessing renal function before starting therapy, as the medication is not recommended for patients with severe renal impairment (eGFR less than 20 mL/min/1.73m²)
  • Consistent effects in people with or without diabetes, as demonstrated in the EMPEROR-Reduced trial 1 and other studies 1.

From the Research

Empagliflozin Addition According to NYHA Classification

  • Empagliflozin (Jardiance) is added to patients with heart failure, as indicated by the New York Heart Association (NYHA) classification, specifically those with class II, III, or IV heart failure and an ejection fraction of 40% or less 2.
  • The addition of Empagliflozin to optimal medical therapy in patients with heart failure with reduced ejection fraction (HFrEF) has been shown to reduce the risk of cardiovascular death and recurrent heart failure hospitalization 3, 2.
  • Patients with symptomatic heart failure due to reduced ejection fraction, classified as NYHA class II-IV, can benefit from the addition of Empagliflozin to their treatment regimen 2, 4.
  • The EMPEROR-Reduced trial demonstrated that Empagliflozin reduced the risk of cardiovascular death or hospitalization for heart failure in patients with NYHA class II, III, or IV heart failure and an ejection fraction of 40% or less, regardless of the presence or absence of diabetes 2.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure.

The New England journal of medicine, 2020

Research

An update on dapagliflozin for the treatment of heart failure.

Drugs of today (Barcelona, Spain : 1998), 2021

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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