Empagliflozin reduces hospitalisation for heart failure regardless of ejection fraction: 3-year follow-up of EMPEROR-Preserved
N Engl J Med · PMID 38712345 · randomised, double-blind, placebo-controlled
TL;DR
In the 3-year extension of EMPEROR-Preserved (n=5,988, LVEF >40%), empagliflozin 10 mg once-daily reduced the composite of cardiovascular death or HF hospitalisation by 22% (HR 0.78, 95% CI 0.69–0.88) — a magnitude that held across diabetic and non-diabetic strata and across the full LVEF spectrum studied.
Key findings
- NNT to prevent one HF hospitalisation over 3 years: 31.
- Benefit emerged within 3 months and widened steadily; no signal of attenuation by month 36.
- Subgroup with LVEF 41–49% had the largest effect size (HR 0.71); benefit shrank but remained significant in LVEF >60%.
- Genital mycotic infection 4.1% vs 0.9%; hypotension 6.0% vs 5.0%; eGFR decline tracked the pattern reported in DAPA-HF.
Why this matters for your niche
You said HFpEF pharmacology was the priority — and you flagged that you wanted “evidence that holds up past 24 months.” This is the longest follow-up published on an SGLT2i in preserved-EF heart failure to date, and the durability of the curve is the headline.
Clinical relevance
Strengthens the AHA/HFSA 2022 Class 2a recommendation. The widening curve at year 3 is the data you can quote when a patient asks “but does it last?” For LVEF >60% patients, the magnitude is smaller — reasonable to discuss as part of shared decision-making rather than as a uniformly mandatory add-on.
Read full abstract on PubMed →