Why the study?
Strict trial selection criteria in EMPEROR-Preserved might reduce the external validity of empagliflozin findings in patients with HFpEF.
A large majority of real-world HFpEF patients are eligible for empagliflozin based on EMPEROR-Preserved criteria, suggesting broad applicability of the trial's findings in clinical practice.
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High eligibility supports considering empagliflozin in most real-world HFpEF patients; leaves open outcome confirmation outside trial populations.
The EMPEROR-Preserved trial demonstrated that the sodium-glucose cotransporter 2 inhibitor empagliflozin reduced the combined endpoint of cardiovascular death or heart failure hospitalization in patients with heart failure with preserved ejection fraction (HFpEF), irrespective of diabetic status. Despite the high potential to change clinical practice, the strict trial selection criteria might reduce external validity of these findings. In this analysis on a contemporary real-world population, we showed that almost two-thirds of HFpEF patients would be candidates for initiation of empagliflozin according to EMPEROR-Preserved criteria. Applying only the trial criteria most likely influencing treatment decisions in clinical practice, the proportion of HFpEF patients potentially eligible to empagliflozin rose to 85%. The demonstrated broad eligibility to empagliflozin in this real-world analysis might predict an extensive use of gliflozins in HFpEF population, with a consequent consistent improvement in cardiovascular outcomes of eligible patients.
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Monzo et al. (2022) studied this question.
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