Many patients with heart failure with reduced ejection fraction (HFrEF) are not treated with target doses of foundational therapies, e.g. renin-angiotensin system inhibitors (angiotensin-converting enzyme [ACE] inhibitors, angiotensin II receptor blockers [ARBs], angiotensin receptor neprilysin inhibitor [ARNI]), β-blockers and mineralocorticoid receptor antagonists (MRAs). However, clinical trials of new heart failure (HF) medicines typically establish optimal dosing on a background of guideline-directed medical therapy (GDMT). Uncertainty may therefore exist regarding the benefit of prescribing new therapies to patients who are not taking GDMT. The authors of this study performed a post hoc analysis of the EMPEROR-Reduced trial to assess the efficacy of empagliflozin versus placebo in patients given <50% or ≥50% of target doses of ACE inhibitors, ARBs, β-blockers, and MRAs (ARNI doses were not recorded consistently). Treatment efficacy was also evaluated for combinations of HF therapies at ≥50% of the target dose or therapeutic combinations including ARNI, all at any dose.
A free full-text PDF of the paper Verma S, et al. Empagliflozin in the treatment of heart failure with reduced ejection fraction in addition to background therapies and therapeutic combinations (EMPEROR-Reduced): a post-hoc analysis of a randomised, double-blind trial. Lancet Diabetes Endocrinol. 2022 Jan;10(1):35-45 is available here.
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