From the Guidelines
Indication for Heart Failure
Jardiance (Empagliflozin) is indicated for the treatment of heart failure with reduced ejection fraction (HFrEF) in adults to reduce the risk of cardiovascular death and hospitalization for heart failure.
Key Points
- The EMPEROR-Preserved trial showed a significant benefit of empagliflozin in patients with symptomatic heart failure with preserved ejection fraction (HFpEF) and elevated natriuretic peptides, with a 21% reduction in the primary composite endpoint of time to heart failure hospitalization or cardiovascular death 1.
- The benefit of empagliflozin was similar irrespective of the presence or absence of diabetes at baseline.
- Empagliflozin has been shown to have beneficial effects on metabolic parameters, including weight loss, blood pressure reduction, and improved glycemic control, which can be beneficial in patients with heart failure, particularly those with diabetes or metabolic syndrome.
Special Populations
- Patients with chronic kidney disease (CKD): Jardiance can help slow the progression of kidney disease and reduce the risk of cardiovascular death and hospitalization for heart failure.
- Patients with diabetes: Jardiance has been shown to have beneficial effects on glycemic control and can be used to reduce the risk of cardiovascular death and hospitalization for heart failure.
Decision Forks
- Patients with heart failure and CKD: Jardiance can be considered to reduce the risk of kidney disease progression and cardiovascular death.
- Patients with heart failure and diabetes: Jardiance can be considered to improve glycemic control and reduce the risk of cardiovascular death and hospitalization for heart failure.
- Patients at risk of hyperkalemia or worsening renal function with other heart failure therapies: Jardiance can be considered as an alternative therapy.
Potential Pit-Falls
- Euglycaemic diabetic ketoacidosis: a potential risk with SGLT2 inhibitors, particularly in patients with poor food intake.
- Genitourinary infections: a potential risk with SGLT2 inhibitors, particularly mycotic infections.
Note: The information provided is based on the available evidence and should be used in conjunction with clinical judgment and patient-specific factors to guide decision-making. 1
From the FDA Drug Label
Indications for Jardiance (Empagliflozin)
Jardiance (Empagliflozin) is indicated for heart failure in the following situations:
- 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 the body 2
Specific Patient Populations
The indication for heart failure applies to adults with heart failure, regardless of the presence of type 2 diabetes or known cardiovascular disease 2
Summary of Indications
The following table summarizes the indications for Jardiance (Empagliflozin):
| Indication | Patient Population |
|---|---|
| Reduce the risk of cardiovascular death and hospitalization for heart failure | Adults with heart failure |
| Reduce the risk of cardiovascular death | Adults with type 2 diabetes and known cardiovascular disease |
From the Research
Indication for Heart Failure
Jardiance (Empagliflozin) is indicated for the treatment of heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) in adults to reduce the risk of cardiovascular death and hospitalization for heart failure, regardless of the presence of diabetes 3, 4, 5.
Key Points
- Empagliflozin has been shown to reduce the risk of cardiovascular death and hospitalization for heart failure in patients with HFrEF and HFpEF, with or without diabetes 3, 4, 5.
- The benefit of empagliflozin is consistent across different subgroups, including patients with different levels of left ventricular ejection fraction and those with or without diabetes 5, 6.
- Empagliflozin has been shown to improve health-related quality of life and reduce the risk of total hospitalizations for heart failure in patients with HFpEF 6, 7.
Special Populations
- Patients with chronic kidney disease (CKD): Empagliflozin can help slow the progression of kidney disease and reduce the risk of cardiovascular death and hospitalization for heart failure 8.
- Patients with diabetes: Empagliflozin has been shown to have beneficial effects on glycemic control and can be used to reduce the risk of cardiovascular death and hospitalization for heart failure 3, 4, 5.
Decision Forks
- Patients with heart failure and CKD: Empagliflozin can be considered to reduce the risk of kidney disease progression and cardiovascular death.
- Patients with heart failure and diabetes: Empagliflozin can be considered to improve glycemic control and reduce the risk of cardiovascular death and hospitalization for heart failure.
- Patients at risk of hyperkalemia or worsening renal function with other heart failure therapies: Empagliflozin can be considered as an alternative therapy.
Potential Pit-Falls
- Euglycaemic diabetic ketoacidosis: a potential risk with SGLT2 inhibitors, particularly in patients with poor food intake.
- Genitourinary infections: a potential risk with SGLT2 inhibitors, particularly mycotic infections.
- Monitoring for adverse effects, especially fluid deficits, is recommended when using empagliflozin in patients with heart failure 3.