Key result
Empagliflozin linked to ~42% lower hazard of HF hospitalization in HFpEF.
Why the study?
The study aimed to evaluate the association of empagliflozin 10 mg once daily with first HF hospitalization, cardiovascular mortality, renal function, health-related quality of life, and safety over 12 months among Pakistani adults with HFpEF.
Is empagliflozin 10 mg once daily added to standard heart failure therapy associated with a lower risk of first unplanned heart failure hospitalization over 12 months compared to standard therapy alone in Pakistani adults with symptomatic HFpEF?
Cohort (n=400)
Echocardiographic operators blinded to treatment-group allocation
Non-randomized
No
Is empagliflozin 10 mg once daily added to standard heart failure therapy associated with a lower risk of first unplanned heart failure hospitalization over 12 months compared to standard therapy alone in Pakistani adults with symptomatic HFpEF?
In a real-world Pakistani cohort with HFpEF, adding empagliflozin 10 mg daily to standard therapy was associated with a 42% lower adjusted hazard of first HF hospitalization, slower eGFR decline, and improved KCCQ-12 quality-of-life scores over 12 months.
Answers are grounded in this paper and cite their sources.
Empagliflozin may lower HF hospitalization risk in HFpEF; hypothesis-generating from observational data and requires randomized confirmation.
Objectives: To evaluate the association of empagliflozin 10 mg once daily with first heart failure (HF) hospitalization among Pakistani adults with heart failure with preserved ejection fraction (HFpEF), and to assess its associations with cardiovascular mortality, renal function, health-related quality of life, and safety during 12 months of follow-up. Methodology: This prospective, single-center observational cohort study included 400 adults with symptomatic HFpEF enrolled at the Karachi Institute of Heart Diseases. Participants were categorized into an empagliflozin group (n=200), receiving empagliflozin 10 mg/day in addition to standard heart failure therapy, and a control group (n=200), receiving standard therapy without an SGLT2 inhibitor. Treatment allocation was non-randomized and reflected routine clinical prescribing. Definite HFpEF was defined by LVEF ≥50%, NYHA class II–IV symptoms, elevated NT-proBNP, and echocardiographic evidence of structural and/or diastolic dysfunction. The primary outcome was first unplanned HF hospitalization during 12 months. Secondary outcomes included all-cause mortality, change in eGFR, and KCCQ-12 score. Results: 5 patients (2.5%) in the empagliflozin group and 7 (3.5%) in the control group lost to follow-up. First HF hospitalization occurred in 36 patients (18.0%) in empagliflozin compared with 60 patients (30.0%) in the control group. After multivariable adjustment, empagliflozin use was associated with a lower hazard of first HF hospitalization (adjusted HR 0.58, 95% CI 0.39–0.86; p=0.007). Cardiovascular mortality occurred in 12 (6.0%) versus 18 (9.0%) patients, respectively, with no statistically significant between-group association (adjusted HR 0.67, 95% CI 0.32–1.39; p=0.28). The annualized eGFR slope was −2.5 mL/min/1.73 m²/year in the empagliflozin group compared with −6.4 mL/min/1.73 m²/year in controls, with an adjusted between-group difference at 12 months of +3.9 mL/min/1.73 m² (95% CI 2.1–5.7; p<0.001). KCCQ-12 scores improved by +8.7 points with empagliflozin compared with +1.9 points in controls, corresponding to an adjusted between-group difference of +5.8 points (95% CI 3.2–8.4; p<0.001). Conclusion: In this prospective observational cohort of Pakistani adults with HFpEF, empagliflozin 10 mg once daily added to standard heart failure therapy was associated with a significantly lower hazard of first HF hospitalization, slower deterioration in renal function, and greater improvement in health-related quality of life over 12 months.
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Sultana et al. (2026) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=400). Empagliflozin vs. Standard heart failure therapy without an SGLT2 inhibitor was evaluated on First unplanned heart failure hospitalization during 12 months (adjusted HR 0.58, 95% CI 0.39–0.86, p=0.007). Empagliflozin 10 mg daily was associated with a lower hazard of first HF hospitalization (18.0% vs 30.0%; adjusted HR 0.58, 95% CI 0.39–0.86; p=0.007) over 12 months in Pakistani adults with HFpEF.
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