From the Guidelines
SGLT2 inhibitors, such as empagliflozin, are recommended for patients with heart failure with preserved ejection fraction (HFpEF) to reduce the risk of heart failure hospitalizations and cardiovascular death, regardless of the presence of diabetes. The EMPEROR-Preserved trial, a recent and high-quality study published in 2022 1, demonstrated a significant benefit of empagliflozin in patients with symptomatic HFpEF, with a 21% reduction in the primary composite endpoint of time to HF hospitalization or cardiovascular death. This benefit was driven mostly by a significant 29% reduction in time to HF hospitalization. The study also showed a significant reduction in total HF hospitalizations, decrease in the slope of the eGFR decline, and a modest improvement in QOL at 52 weeks.
The use of SGLT2 inhibitors in HFpEF patients is supported by multiple studies, including the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1. These guidelines recommend the use of SGLT2 inhibitors, such as empagliflozin, in patients with HFpEF, regardless of the presence of diabetes. The guidelines also emphasize the importance of monitoring patients for potential side effects, including genital mycotic infections, urinary tract infections, and volume depletion.
Key points to consider when using SGLT2 inhibitors in HFpEF patients include:
- Monitoring for potential side effects, such as genital mycotic infections, urinary tract infections, and volume depletion
- Advising patients to maintain adequate hydration and adjusting diuretic doses as needed
- Using SGLT2 inhibitors alongside standard heart failure therapies, such as diuretics, ACE inhibitors/ARBs, beta-blockers, and mineralocorticoid receptor antagonists
- Considering the use of SGLT2 inhibitors in patients with HFpEF, regardless of the presence of diabetes, as the benefit was similar in both diabetic and non-diabetic patients in the EMPEROR-Preserved trial 1.
It is also important to note that the benefit of SGLT2 inhibitors in HFpEF patients was consistent across different LVEF subgroups, although there was a signal for lower benefit at higher LVEFs >62.5% 1. Overall, the use of SGLT2 inhibitors, such as empagliflozin, is a valuable addition to the management of HFpEF patients, and can help reduce the risk of heart failure hospitalizations and cardiovascular death.
From the Research
SGLT2 Inhibitors for Heart Failure with Preserved Ejection Fraction (HFpEF)
- SGLT2 inhibitors have shown promising results in patients with HFpEF, a condition characterized by a left ventricular ejection fraction (LVEF) of ≥50% 2, 3.
- The EMPEROR-Preserved study demonstrated that therapy with the SGLT2 inhibitor empagliflozin significantly reduced hospitalization for heart failure in patients with HFpEF, although cardiovascular mortality was not affected 3.
- A literature review found that dapagliflozin and empagliflozin have shown consistent improvement in the combined outcome of cardiovascular death and hospitalization for heart failure in a broad population of heart failure patients, including those with HFpEF 4.
- In patients with HFpEF, SGLT2 inhibitors have been found to reduce heart failure hospitalizations, with the most benefit seen in patients with frequent symptoms or hospitalizations for heart failure 4.
Benefits and Considerations of SGLT2 Inhibitors for HFpEF
- SGLT2 inhibitors have been found to improve diastolic dysfunction parameters and reduce hospitalization for heart failure in patients with HFpEF 2, 3.
- The use of SGLT2 inhibitors in older adults with HFpEF requires consideration of age-related changes in pharmacokinetics and pharmacodynamics, as well as the concurrence of geriatric conditions such as polypharmacy and frailty 5.
- SGLT2 inhibitors may be used as part of a comprehensive treatment plan for HFpEF, including loop diuretics, mineralocorticoid receptor antagonists, and other therapies 5.
Current State of Research on SGLT2 Inhibitors for HFpEF
- Recent studies have provided evidence for the benefits of SGLT2 inhibitors in patients with HFpEF, although further research is needed to fully understand their effects on cardiovascular outcomes 2, 3, 4.
- The treatment of HFpEF has made progress with the use of SGLT2 inhibitors, but there is still work to be done to improve symptom control and reduce hospitalizations for heart failure 4.
- Ongoing research aims to clarify the role of SGLT2 inhibitors in the management of HFpEF and to identify the most effective treatment strategies for this patient population 2, 3, 4.