Physicians' Academy for Cardiovascular Education

SGLT2i safe and effective in HFpEF across all age groups

According to a prespecified analysis of the EMPEROR-Preserved trial, age does not influence the benefits seen with empagliflozin in HFpEF. Moreover, elderly patients tolerated the drug well.

Literature - Böhm M, Butler J, Filippatos G, et al. - J Am Coll Cardiol. 2022 Jul 5;80(1):1-18. doi: 10.1016/j.jacc.2022.04.040

Introduction and methods

//Background and aim of the study//

Empagliflozin reduces the combined risk of CVD or HF hospitalization in HFpEF patients, as shown in the recent EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction) trial [1]. There may be general concerns about decreased treatment effects and more adverse events with advanced age [2]. The aim of this analysis was to evaluate the interplay of age with the efficacy and safety of empagliflozin in the EMPEROR-Preserved trial.


The EMPEROR-Preserved trial was a double-blind RCT in which 5988 patients with HF (NYHA class II–IV symptoms) and EF >40% were randomized (1:1 ratio) to empagliflozin 10 mg daily or placebo. For the current, prespecified analysis, the patients were divided into 4 groups according to their baseline age: <65 years (n=1199), 65–74 years (n=2214), 75–79 years (n=1276), and ≥80 years (n=1299).


The primary endpoint was the time to first event of the composite outcome of adjudicated CV death or HF hospitalization. The first secondary endpoint was the occurrence of total (first and recurrent) adjudicated HF hospitalizations. The second secondary endpoint was the slope of the change in eGFR. Health-related quality of life (HRQoL )—based on the Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score (KCCQ-CSS)—and frequency of adverse events were also assessed.

Main results

Efficacy outcomes

eGFR slope

Other outcomes


In a prespecified analysis of the EMPEROR-Preserved trial, age did not influence the beneficial effects empagliflozin had on reducing CV death or HF hospitalization, total HF hospitalizations, and eGFR decline or on improving HRQoL. In addition, older age was not associated with clinically meaningful safety concerns.


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Find this article online at JAMA Cardiol.

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