NICE guidance - empagliflozin for treating chronic heart failure with reduced ejection fraction (HFrEF)

Last edited 03/2022 and last reviewed 05/2023

Empagliflozin for treating chronic heart failure with reduced ejection fraction (HFrEF)

NICE suggest that (1):

• Empagliflozin is recommended as an option for treating symptomatic chronic heart failure with reduced ejection fraction in adults, only if it is used as an add-on to optimised standard care with:
  • an angiotensin-converting enzyme (ACE) inhibitor or angiotensin 2 receptor blocker (ARB), with a beta blocker and, if tolerated, a mineralocorticoid receptor antagonist (MRA), or
  • sacubitril valsartan with a beta blocker and, if tolerated, an MRA.
• Start empagliflozin for treating symptomatic heart failure with reduced ejection fraction on the advice of a heart failure specialist. Monitoring should be done by the most appropriate healthcare professional

Study evidence supporting use of empagliflozin in HFrEF comes from the Emperor Reduced study where the authors concluded that (2):

• among patients receiving recommended therapy for heart failure, those in the empagliflozin group had a lower risk of cardiovascular death or hospitalization for heart failure than those in the placebo group, regardless of the presence or absence of diabetes
• during the trial period, the number of patients who would need to have been treated with empagliflozin to prevent one primary event was 19 (95% CI, 13 to 37)

Reference:

• NICE (March 2022). Empagliflozin for treating chronic heart failure with reduced ejection fraction
• Packer S et al.Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure . NEJM 2020; DOI: 10.1056/NEJMoa2022190