Early Efficacy of Empagliflozin in Addition to Optimal Medical Treatment of Heart Failure with Reduced Ejection Fraction

Introduction: Heart failure with reduced ejection fraction (HFrEF) is a life-threatening condition that can lead to unfavorable clinical outcomes. It is recommended to add a sodium-glucose cotransporter 2 (SGLT2) inhibitor to previous mortality-reducing pharmacological therapy. Full treatment access may be limited by costs in many countries, and early benefits with guideline-directed medical therapy must be proven and reinforced. Objective: We aimed to analyze the short-term impact of empagliflozin on HFrEF patients concerning functional capacity, quality of life and left ventricle remodeling. Methods: Prospective observational study that analyzed patients with HFrEF on triple therapy and were indicated to use SGLT2 inhibitor. A six-month follow-up was conducted for patients who adhered to empagliflozin use with no interruptions or complications. To compare the initial and final periods, patients performed the six-minute walk test (6MWT), the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and echocardiograms. The chi-square test, the Fisher’s test and the paired Student’s t-test were used for comparative analyses before and after treatment for six months, with a significance level of 0.05. Results: Thirty patients were analyzed, mean age 61.9 ± 7.1, 30% female, 40% diabetic. The distance walked in the 6MWT raised from 372 ± 89m to 402 ± 53m (p=0.034); quality of life improved from 36.4 ± 24 points to 21.4 ± 17 points in the MLHFQ (p=0.0002); left ventricular ejection fraction raised from 30.4 ± 6% to 40.3 ± 13% (p=0.0001); left ventricular systolic diameter reduced from 49.7 ± 7mm to 45.3 ± 11mm (p=0.014). Mean left ventricular diastolic diameter was 58.7 ± 9mm at inclusion and 56.9 ± 9mm at the end of six months (p=0.29). Conclusion: There was an improvement in functional capacity, quality of life, cardiac function and left ventricle remodeling on echocardiogram after six months of empagliflozin use added to triple therapy in HFrEF.