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Clinical Trial
. 2020 Jan;22(1):126-135.
doi: 10.1002/ejhf.1663. Epub 2019 Dec 9.

Efficacy of empagliflozin on heart failure and renal outcomes in patients with atrial fibrillation: data from the EMPA-REG OUTCOME trial

Michael Böhm  1 , Jonathan Slawik  1 , Martina Brueckmann  2   3 , Michaela Mattheus  4 , Jyothis T George  2 , Anne Pernille Ofstad  5 , Silvio E Inzucchi  6 , David Fitchett  7 , Stefan D Anker  8   9   10 , Nikolaus Marx  11 , Christoph Wanner  12 , Bernard Zinman  13 , Subodh Verma  14
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Free article
Clinical Trial

Efficacy of empagliflozin on heart failure and renal outcomes in patients with atrial fibrillation: data from the EMPA-REG OUTCOME trial

Michael Böhm et al. Eur J Heart Fail. 2020 Jan.
Free article

Abstract

Aims: Atrial fibrillation (AF) is common in patients with diabetes and heart failure (HF) and increases the future risk of adverse cardiovascular (CV) outcomes. This analysis from the EMPA-REG OUTCOME trial explores CV and renal outcomes in patients with vs. without AF at baseline and assesses the benefits of empagliflozin.

Methods and results: Analyses were conducted on patients distinguished by the presence (n = 389) or absence (n = 6631) of AF at baseline. Outcome events were more frequent in patients with AF than those without AF. Empagliflozin compared to placebo reduced CV death or HF hospitalisation consistently in patients with AF [hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.36-0.92] and without AF (HR 0.67, 95% CI 0.55-0.82, Pinteraction = 0.56). Similar results were observed for the components of this endpoint, all-cause mortality, new or worsening nephropathy, first introduction of loop diuretics, or occurrence of oedema. The absolute number of prevented events was higher in patients with AF, resulting in larger absolute treatment effects of empagliflozin. New loop diuretics or oedema were associated with increased rates of subsequent events, and rates appeared lower in those randomised to empagliflozin.

Conclusions: In patients with type 2 diabetes mellitus and established CV disease, those with AF at baseline had higher rates of adverse HF outcomes than those without AF. Irrespective of the presence of AF, empagliflozin reduced HF-related and renal events. The absolute number of prevented events is higher in patients with AF than without AF. Patients with diabetes, CV disease and AF may especially benefit from use of empagliflozin.

Keywords: Diabetes; Empagliflozin; Heart failure; Mortality; Oedema; SGLT2 inhibitors.

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References

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