Outcomes of empagliflozin versus dapagliflozin treatment in patients with heart failure based on left ventricular ejection fraction: a multicentre cohort study

Abstract Background and Aims Heart failure (HF) is a major global health concern, and sodium-glucose cotransporter-2 inhibitors have emerged as important therapeutic options. However, their comparative effectiveness in a real-world population remains uncertain. This study aimed to investigate and compare the outcomes associated with empagliflozin and dapagliflozin use in patients with HF. Methods We analysed data from a clinical data warehouse encompassing seven medical centres. Patients diagnosed with HF who were prescribed empagliflozin or dapagliflozin were included. We stratified the overall patients according to left ventricular ejection fraction (LVEF): LVEF≤ 40%, 40LVEF50%, and 50%≤LVEF groups. Each group was then stratified into subgroups of patients taking empagliflozin or dapagliflozin. The primary outcome was a composite of cardiovascular death or hospitalisation due to HF, analysed as the first event occurring after starting each medication. The secondary outcomes included individual components, all-cause death, and cardiovascular hospitalisation. Results A total of 6,964 patients (3,170 in the empagliflozin subgroup and 3,794 in the dapagliflozin subgroup) were included. The mean age was 68.0 years, with females comprising 2700 (60.2%) patients. The median follow-up duration was 16.0 months. Empagliflozin and dapagliflozin showed no significant difference in the primary outcome (13.8% vs. 14.8% in LVEF≤ 40%, 5.5% vs. 5.3% in 40LVEF50%, 4.8% vs. 6.0% in 50%≤LVEF), without heterogeneity (P for interaction=0.777). Conclusions This study suggests that dapagliflozin and empagliflozin have similar clinical outcomes in the management of HF across all ranges of LVEF in a real-world setting.