Mortality and Hospitalization Rate of Heart Failure Patients with Preserved Ejection Fraction Treated with Dapagliflozin vs. Empagliflozin

Background: Sodium–Glucose cotransporter 2 (SGLT-2) inhibitors, such as dapagliflozin and empagliflozin, are commonly used to treat type 2 diabetes mellitus, chronic kidney disease, and heart failure with reduced ejection fraction. Recent landmark trials, EMPEROR-Preserved and DELIVER, have demonstrated that both drugs can improve cardiovascular outcomes in heart failure patients with preserved ejection fraction (HFpEF). However, differences in the primary outcomes between these trials were observed when stratified by Asian subgroups. Methods: This study analyzed data from 59 adults using empagliflozin and 26 using dapagliflozin at Princess Margaret Hospital between August 2016 and March 2022. The primary composite outcome was combined cardiovascular death and hospitalization due to heart failure. Results were stratified using a Cox proportional-hazards model. Furthermore, the occurrence of side effects was evaluated and reported as safety outcomes. Results: The study found that the cardiovascular and mortality outcomes were higher than previously reported in the literature. The use of empagliflozin resulted in 24.9 composite outcome events per 100 patient years, whereas the use of dapagliflozin resulted in 29.9 events per 100 patient years. Patients taking empagliflozin without heart failure hospitalization in the past 12 months had significantly better composite outcomes than those taking dapagliflozin (hazard ratio, 0.30; 95% confidence interval, 0.12–0.76). However, no significant differences were observed in the composite outcome and all-cause mortality between the two drugs. Conclusion: A substantial initial decrease in overall survival toward the primary composite outcome within the first year after the start of SGLT-2 inhibitor administration indicates the need for early intervention for this specific patient subgroup. Although constrained by a modest sample size obtained from a single center, the findings of this study highlight the importance of conducting additional research to explore the comparative efficacy of SGLT-2 inhibitors for HFpEF in a larger local population.