Early benefit with empagliflozin in heart failure with preserved ejection fraction: insights from the EMPEROR-Preserved trial.

Patients with chronic or worsening heart failure (HF) are at a high risk for morbidity, mortality and impaired health related quality of life (HRQoL). This risk is present in the short-term and increases significantly once hospitalized. Thus, it is crucial that HF therapies not only improve outcomes, but do so early post -initiation. The recent EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction) trial studied empagliflozin in patients with HFpEF and showed a significant reduction in the risk of cardiovascular death or HF hospitalization. This benefit also extended to health and functional status. We highlight that this benefit was early with Cox regression analysis achieved nominal statistical significance for separation between the empagliflozin and the placebo arms by day-18 for time to cardiovascular death or HF hospitalization (hazard ratio at 18 days, 0.41 [95% CI, 0.17–0.99]) and sustained for the rest of the trial period. A similar pattern of early and sustained benefit was seen for all domains of HRQoL scores and New York Heart Association functional class with significant improvement when first assessed at 3-months and 4 weeks, respectively. Our results reinforce the importance of early initiation of treatment in patients with HFpEF.