Consider this SGLT2 inhibitor for patients with HF with preserved ejection fraction
The addition of empagliflozin to usual therapy reduced hospitalization risk, regardless of patients’ diabetes status.
PRACTICE CHANGER
Consider adding empagliflozin 10 mg to usual therapy to reduce hospitalization of symptomatic patients with
STRENGTH OF RECOMMENDATION
B: Based on a single, good-quality, multicenter, randomized controlled trial.1
Anker SD, Butler J, Filippatos G, et al; EMPEROR-Preserved Trial Investigators. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385:1451-1461. doi: 10.1056/NEJM oa2107038
The study’s generalizability was further limited by its significant exclusion criteria, which included elevated blood pressure, chronic obstructive pulmonary disease on home oxygen, liver disease, renal disease with an eGFR < 20 mL/min/1.73 m2 or requiring dialysis, and BMI ≥ 45.
Finally, only 12% of patients were from North America, and results were not significant for this subgroup (HR = 0.72; 95% CI, 0.52-1.00), which may challenge its external validity. The authors noted that 23% of patients discontinued treatment for reasons other than death, which may have driven the null effect.
CHALLENGES TO IMPLEMENTATION
Empagliflozin is expensive,but coverage may improve
Cost could be a major barrier to implementation. Retail pricing for empagliflozin is estimated to be more than $550 per month, which may be prohibitive for patients with no insurance or with higher-deductible plans.11 However, the US Food and Drug Administration has approved empagliflozin to reduce the risk of CV death and hospitalization for HF in adults,12 which may help to improve insurance coverage.
