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Efficacy and safety of empagliflozin according to background diuretic use in HFrEF: post-hoc analysis of EMPEROR-reduced

Background - The EMPEROR-Reduced (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction) trial established the efficacy of empagliflozin in reducing heart failure (HF) outcomes among patients with heart failure with reduced ejection fraction (HFrEF). - Obj...

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Main Authors: Dhingra, Nitish (Author) , Verma, Subodh (Author) , Butler, Javed (Author) , Anker, Stefan D. (Author) , Ferreira, Joao Pedro (Author) , Filippatos, Gerasimos (Author) , Januzzi, James L. (Author) , Lam, Carolyn S. P. (Author) , Sattar, Naveed (Author) , Zaremba-Pechmann, Liliana (Author) , Böhm, Michael (Author) , Nordaby, Matias (Author) , Brückmann, Martina (Author) , Pocock, Stuart J. (Author) , Zannad, Faiez (Author) , Packer, Milton (Author)
Format: Article (Journal)
Language:English
Published: January 2024
In: JACC Heart failure
Year: 2024, Volume: 12, Issue: 1, Pages: 35-46
ISSN:2213-1787
DOI:10.1016/j.jchf.2023.06.036
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.jchf.2023.06.036
Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S2213177923004535
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Author Notes:Nitish K. Dhingra, MD, Subodh Verma, MD, PHD, Javed Butler, MD, MPH, MBA, Stefan D. Anker, MD, PHD, Joao Pedro Ferreira, MD, Gerasimos Filippatos, MD, James L. Januzzi, MD, Carolyn S.P. Lam, PHD, MBBS, Naveed Sattar, MD, Liliana Zaremba-Pechmann, PHD, Michael Böhm, MD, Matias Nordaby, MD, Martina Brueckmann, MD, Stuart J. Pocock, PHD, Faiez Zannad, MD, PHD, Milton Packer, MD, on behalf of the EMPEROR-Reduced Trial Committees and Investigators
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Summary:Background - The EMPEROR-Reduced (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction) trial established the efficacy of empagliflozin in reducing heart failure (HF) outcomes among patients with heart failure with reduced ejection fraction (HFrEF). - Objectives - The authors examined the outcomes of EMPEROR-Reduced as a function of background diuretic therapy. - Methods - The EMPEROR-Reduced trial was a double-blind, randomized controlled trial of placebo vs empagliflozin 10 mg among 3,730 HFrEF patients. Herein, the population was stratified into 4 groups: no diuretic and diuretic dose equivalent to furosemide <40, 40, and >40 mg daily at baseline. - Results - A total of 3,656 patients from the EMPEROR-Reduced trial were available for analysis. Of those patients, 482 (13.2%) were receiving no diuretic therapy, and 731 (20.0%), 1,411 (38.6%), and 1,032 (28.2%) were receiving <40 mg, 40 mg, and >40 mg, respectively. The efficacy of empagliflozin on the primary outcome (time to first event of hospitalization for HF or cardiovascular [CV] death) was consistent regardless of background diuretic therapy (>40 mg: HR: 0.88 [95% CI: 0.71-1.10]; 40 mg: HR: 0.65 [95% CI: 0.51-0.82]; <40 mg: HR: 0.65 [95% CI: 0.46-0.92]); no diuretic agents: HR: 0.78 [95% CI: 0.47-1.29]; Ptrend test = 0.192). Baseline diuretic doses did not influence the effect of empagliflozin on body weight, systolic blood pressure, NT-proBNP, or hematocrit at 52 weeks. The safety profile of empagliflozin vs placebo was unaffected by baseline diuretic dose; however, independently of treatment allocation, total rates of adverse events were higher among patients with higher baseline doses of diuretic agents. - Conclusions - Empagliflozin exhibits a consistent effect on time to CV death or HF hospitalization and an unaltered safety profile regardless of baseline diuretic therapy.
Item Description:Online verfügbar: 13. September 2023, Artikelversion: 2. Januar 2024
Gesehen am 01.07.2024
Physical Description:Online Resource
ISSN:2213-1787
DOI:10.1016/j.jchf.2023.06.036

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