P4736Empagliflozin targeting the real-world heart failure population

Abstract

Introduction: Heart Failure (HF) is an increasingly prevalent syndrome with burdensome mortality, morbidity and costs. Its prognosis is further aggravated by concomitant comorbidities, often including diabetes mellitus (DM). The EMPAREG OUTCOMES trial showed that empagliflozin compared to placebo significantly reduced hospitalization for HF in diabetic patients. Purpose: To investigate which patients with both HF and DM are potential candidates to start empagliflozin. Methods: This analysis was based on a prospective observational cohort enrolling 771 consecutive patients admitted to an Internal Medicine Ward between October 2013 and October 2014. Of these, the HF population was selected and further analyzed. The key criteria for empagliflozin candidate selection were similar to EMPA-REG OUTCOMES trial protocol (hemoglobin A1c 7-10%, high cardiovascular risk events and estimated glomerular filtration rate [eGFR] ≥30mL/min/1,73m2). The European Medicine Agency (EMA) criteria (eGFR>60mL/min/1,73m2) were also considered. Results: 41,1% (n=317) had HF and, of these, 40,4% (n=128) had concurrently type 2 DM. Nine (7,0%) patients were excluded from analysis due to in-hospital death. The demographic characteristics are depicted in table 1. According to EMPA-REG OUTCOMES trial key criteria, 17 (14,3%) patients were to be excluded due to eGFR <30mL/min/1.73m2; 17,6% (n=21) of those with both HF and DM (6,6% of the overall HF cohort) would have been suitable for empagliflozin. Additionally, when considering the EMA criteria, only 6,7% (n=8) would have been candidates to start the treatment. (Table presented) (Figure presented) Conclusions: Although the EMPA-REG OUTCOMES trial emphasized the potential benefits of empagliflozin in HF outcomes, the real-world applicability of this treatment is restricted solely to a fairly small subgroup of these high risk HF patients.