Empagliflozin and heart failure: position paper of the experts on the results of the online meeting and discussion of the EMPEROR-Preserved Trial

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Abstract

At an international online expert meeting held on September 16, 2021, the results of the empagliflozin research program EMPA-REG Outcome, EMPEROR-Reduced and EMPEROR-Preserved were reviewed. We analyzed cardiovascular and renal outcomes during the treatment with empagliflozin in patients with chronic heart failure, regardless of the presence of type 2 diabetes mellitus. The positive results of the EMPEROR-Preserved study are updated and their significance for clinical practice is discussed. Several proposals have been adopted that will accelerate the introduction of empagliflozin therapy into practice in patients with heart failure and overcome clinical inertia.

About the authors

Gregory P. Arutyunov

Pirogov Russian National Research Medical University

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0002-6645-2515

чл.-кор. РАН, д-р мед. наук, зав. каф. внутренних болезней и общей физиотерапии

Russian Federation, Moscow

Yuri M. Lopatin

Volgograd State Medical University; Volgograd Regional Clinical Cardiology Center

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0001-8744-7144

д-р мед. наук, проф., зав. каф. кардиологии, сердечно-сосудистой и торакальной хирургии Института непрерывного медицинского и фармацевтического образования, зав. отд-нием

Russian Federation, Volgograd; Volgograd

Aleksandr S. Ametov

Russian Medical Academy of Continuous Professional Education

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0002-7936-7619

д-р мед. наук, проф., зав. каф. Эндокринологии

Russian Federation, Moscow

Fail T. Ageev

National Medical Research Center of Cardiology

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0003-4369-1393

д-р мед. наук, проф., рук. научно-диспансерного отд. Института клинической кардиологии им. А.Л. Мясникова

Russian Federation, Moscow

Mikhail B. Antsiferov

Endocrinology Dispensary

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0002-9944-2997

д-р мед. наук, проф., глав. врач

Russian Federation, Moscow

Svetlana V. Villevalde

Pirogov Russian National Research Medical University; Almazov National Medical Research Centre

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0001-7652-2962

д-р мед. наук, проф., зав. каф. кардиологии фак-та подготовки кадров высшей квалификации Института медицинского образования, нач. службы анализа и перспективного планирования Управления по реализации федеральных проектов

Russian Federation, Moscow; Saint Petersburg

Nadezhda G. Vinogradova

Privolzhsky Research Medical University

Email: vinogradovang@yandex.ru
ORCID iD: 0000-0002-3391-7937

д-р мед. наук, доц. каф. терапии и кардиологии

Russian Federation, Nizhny Novgorod

Gagik R. Galstyan

Endocrinology Research Centre

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0001-6581-4521

д-р мед. наук, проф., и.о. зам. дир. Института диабета, зав. отд-нием диабетической стопы

Romania, Moscow

Albert S. Galyavich

Kazan State Medical University

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0002-4510-6197

д-р мед. наук, проф., зав. каф. кардиологии ФПК и ППС, гл. внештатный кардиолог ПФО

Russian Federation, Kazan

Sergey R. Gilyarevskiy

Russian Medical Academy of Continuous Professional Education

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0002-8505-1848

д-р мед. наук, проф., проф. каф. клинической фармакологии и терапии им. Б.Е. Вотчала

Russian Federation, Moscow

Maria G. Glezer

Sechenov First Moscow State Medical University (Sechenov University)

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0002-0995-1924

д-р мед. наук, проф. каф. профилактической и неотложной кардиологии НИО

Russian Federation, Moscow

Igor V. Zhirov

Russian Medical Academy of Continuous Professional Education; National Medical Research Center of Cardiology

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0002-4066-2661

д-р мед. наук, проф. каф. кардиологии, вед. науч. сотр. отд. заболеваний миокарда и сердечной недостаточности

Russian Federation, Moscow; Moscow

Mikhail V. Ilyin

Yaroslavl State Medical University

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0001-6278-374X

д-р мед. наук, декан фак-та подготовки кадров высшей квалификации, зав. каф. терапии ИПДО

Russian Federation, Yaroslavl

Anastasiya Iu. Lebedeva

Pirogov Russian National Research Medical University; Davydovsky City Clinical Hospital

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0002-4060-0786

д-р мед. наук, проф. каф. госпитальной терапии №1, зам. глав. врача по медицинской части

Russian Federation, Moscow; Moscow

Sergey M. Nedogoda

Volgograd State Medical University

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0001-5981-1754

д-р мед. наук, проф., зав. каф. внутренних болезней Института непрерывного медицинского и фармацевтического образования

Russian Federation, Volgograd

Vladimir V. Salukhov

Kirov Military Medical Academy

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0003-1851-0941

д-р мед. наук, проф., нач. 1-й каф. терапии усовершенствования врачей

Russian Federation, Saint Petersburg

Ekaterina I. Tarlovskaya

Privolzhsky Research Medical University

Author for correspondence.
Email: etarlovskaya@mail.ru
ORCID iD: 0000-0002-9659-7010

д-р мед. наук, проф., зав. каф. терапии и кардиологии

Russian Federation, Nizhny Novgorod

Sergey N. Tereshchenko

National Medical Research Center of Cardiology

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0001-9234-6129

д-р мед. наук, проф., рук. отд. заболеваний миокарда и сердечной недостаточности

Russian Federation, Moscow

Igor V. Fomin

Privolzhsky Research Medical University

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0003-0258-5279

д-р мед. наук, доц., зав. каф. госпитальной терапии

Russian Federation, Nizhny Novgorod

Iurii Sh. Khalimov

Kirov Military Medical Academy

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0002-7755-7275

д-р мед. наук, проф., нач. каф. военно-полевой терапии

Russian Federation, Saint Petersburg

Niaz R. Khasanov

Kazan State Medical University

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0002-7760-0763

д-р мед. наук, проф., зав. каф. пропедевтики внутренних болезней им. проф. С.С. Зимницкого

Russian Federation, Kazan

Dmitriy V. Cherkashin

Kirov Military Medical Academy

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0003-1363-6860

д-р мед. наук, проф., нач. каф. военно-морской терапии

Russian Federation, Saint Petersburg

Sergey S. Yakushin

Pavlov Ryazan State Medical University

Email: etarlovskaya@mail.ru
ORCID iD: 0000-0002-1394-3791

д-р мед. наук, проф., зав. каф. госпитальной терапии с курсом медико-социальной экспертизы

Russian Federation, Ryazan

References

  1. Краием Н., Поляков Д.С., Фомин И.В., и др. Динамика распространенности хронической сердечной недостаточности и сахарного диабета в Нижегородской области с 2000 по 2017 год. Кардиология. 2018;58(2S):25-32 [Kraiem N, Poliakov DS, Fomin IV, et al. Dynamics of the prevalence of chronic heart failure and diabetes mellitus in the Nizhny Novgorod region from 2000 to 2017. Kardiologiia. 2018;58(2S):25-32 (in Russian)]. doi: 10.18087/cardio.2439
  2. Фомин И.В. Хроническая сердечная недостаточность в Российской Федерации: что сегодня мы знаем и что должны делать. Российский кардиологический журнал. 2016;8:7-13 [Fomin IV. Chronic heart failure in the Russian Federation: what we know today and what we should do. Rossiiskii kardiologicheskii zhurnal. 2016;8:7-13 (in Russian)]. doi: 10.15829/1560-4071-2016-8-7-13
  3. Mamas MA, Sperrin M, Watson MC, et al. Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10-year follow-up in Scotland. Eur J Heart Fail. 2017;19(9):1095-104. doi: 10.1002/ejhf.822
  4. Levy D, Kenchaiah S, Larson MG, et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med. 2002;347(18):1397-402. doi: 10.1056/NEJMoa020265
  5. Maggioni AP, Dahlström U, Filippatos, et al. EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot); Heart Failure Association of the European Society of Cardiology (HFA). Eur J Heart Fail. 2013;15(7):808-17. doi: 10.1093/eurjhf/hft050
  6. Терещенко С.Н., Галявич А.С., Ускач Т.М., и др. Хроническая сердечная недостаточность. Клинические рекомендации 2020. Российский кардиологический журнал. 2020;25(11):311-74 [Tereshchenko SN, Galiavich AS, Uskach TM, et al. Chronic heart failure. Clinical guidelines 2020. Rossiiskii kardiologicheskii zhurnal. 2020;25(11):311-74 (in Russian)]. doi: 10.15829/1560-4071-2020-4083
  7. McDonagh TA, Metra M, Adamo M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726. doi: 10.1093/eurheartj/ehab368
  8. Rosano GMC, Moura B, Metra M, et al. Patient profiling in heart failure for tailoring medical therapy. A consensus document of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2021;23(6):872-81. doi: 10.1002/ejhf.2206
  9. Kapoor JR, Kapoor R, Ju C, et al. Precipitating Clinical Factors, Heart Failure Characterization, and Outcomes in Patients Hospitalized With Heart Failure With Reduced, Borderline, and Preserved Ejection Fraction. JACC Heart Fail. 2016;4(6):464-72. doi: 10.1016/j.jchf.2016.02.017
  10. Агеев Ф.Т., Овчинников А.Г. Сердечная недостаточность с промежуточной фракцией выброса левого желудочка: существует ли клиническая необходимость выделения ее в отдельную подгруппу? Кардиология. 2018;58(12S):4-10 [Ageev FT, Ovchinnikov AG. Heart failure with intermediate ejection fraction of the left ventricle: is there a clinical need to separate it into a separate subgroup? Kardiologiia. 2018;58(12S):4-10 (in Russian)]. doi: 10.18087/cardio.2609
  11. Koh AS, Tay WT, Teng THK, et al. A comprehensive population based characterization of heart failure with mid range ejection fraction: Characteristics and outcomes in HFmrEF. Eur J Heart Fail. 2017;19(12):1624-34. doi: 10.1002/ejhf.945
  12. Дедов И.И., Шестакова М.В., Викулова О.К. Эпидемиология сахарного диабета в Российской Федерации: клинико-статистический анализ по данным Федерального регистра сахарного диабета. Сахарный диабет. 2017;20(1):13-41 [Dedov II, Shestakova MV, Vikulova OK. Epidemiology of Diabetes Mellitus in the Russian Federation: Clinical and Statistical Analysis According to the Federal Register of Diabetes Mellitus. Sakharnyi diabet. 2017;20(1):13-41 (in Russian)]. doi: 10.14341/DM8664
  13. Khatibzadeh S, Farzadfar F, Oliver J, et al. Worldwide risk factors for heart failure: a systematic review and pooled analysis. Int J Cardiol. 2013;168(2):1186-94. doi: 10.1016/j.ijcard.2012.11.065
  14. Tsao CW, Lyass A, Enserro D, et al. Temporal Trends in the Incidence of and Mortality Associated With Heart Failure With Preserved and Reduced Ejection Fraction. JACC Heart Fail. 2018;6(8):678-85. doi: 10.1016/j.jchf.2018.03.006
  15. Ощепкова Е.В., Лазарева Н.В., Салтыкова Д.Ф., Терещенко С.Н. Первые результаты Российского регистра хронической сердечной недостаточности. Кардиология. 2015;55(5):22-8 [Oshchepkova EV, Lazareva NV, Saltykova DF, Tereshchenko SN. First results of the Russian register of chronic heart failure. Kardiologiia. 2015;55(5):22-8 (in Russian)]. doi: 10.18565/cardio.2015.5.22-28
  16. Shah KS, Xu H, Matsouaka RA, et al. Heart Failure With Preserved, Borderline, and Reduced Ejection Fraction: 5-Year Outcomes. J Am Coll Cardiol. 2017;70(20):2476-86. doi: 10.1016/j.jacc.2017.08.074
  17. Zinman B, Wanner C, Lachin JM, et al.; EMPA-REG OUTCOME Investigators. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373(22):2117-28. doi: 10.1056/NEJMoa1504720
  18. Fitchett D, Zinman B, Wanner C, et al. Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high cardiovascular risk: results of the EMPA-REG OUTCOME trial. Eur Heart J. 2016;37(19):1526-34. doi: 10.1093/eurheartj/ehv728
  19. Barnett AH, Mithal A, Manassie J, et al. Efficacy and safety of empagliflozin added to existing antidiabetes treatment in patients with type 2 diabetes and chronic kidney disease: a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2014;2(5):369-84. doi: 10.1016/S2213-8587(13)70208-0
  20. Scheen AJ. Sodium-glucose cotransporter type 2 inhibitors for the treatment of type 2 diabetes mellitus. Nat Rev Endocrinol. 2020;16:556-77. doi: 10.1038/s41574-020-0392-2
  21. Cowie M, Fisher M. SGLT2 inhibitors: mechanisms of cardiovascular benefit beyond glycaemic control. Nat Rev Cardiol. 2020;17:761-72. doi: 10.1038/s41569-020-0406-8
  22. Anker SD, Khan MSh, Shahid I, et al. Sodium-glucose co-transporter 2 inhibitors in heart failure with preserved ejection fraction: reasons for optimism. Eur J Heart Fail. 2021;23(8):1250-5. doi: 10.1002/ejhf.2279
  23. Packer M, Anker SD, Butler J, et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med. 2020;383(15):1413-24. doi: 10.1056/NEJMoa2022190
  24. Anker SD, Butler J, Filippatos G, et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. EMPEROR-Preserved Trial Investigators. N Engl J Med. 2021;385(16):1451-61. doi: 10.1056/NEJMoa2107038
  25. Packer M, Butler J, Filippatos GS, et al. Evaluation of the effect of sodium-glucose co-transporter 2 inhibition with empagliflozin on morbidity and mortality of patients with chronic heart failure and a reduced ejection fraction: rationale for and design of the EMPEROR-Reduced trial. Eur J Heart Fail. 2019;21(10):1270-8. doi: 10.1002/ejhf.1536
  26. Виноградова Н.Г., Поляков Д.С., Фомин И.В. Анализ смертности у пациентов с ХСН после декомпенсации при длительном наблюдении в условиях специализированной медицинской помощи и в реальной клинической практике. Кардиология. 2020;60(4) [Vinogradova NG, Poliakov DS, Fomin IV. Analysis of mortality in patients with CHF after decompensation during long-term follow-up in specialized medical care and in real clinical practice. Kardiologiia. 2020;60(4) (in Russian)]. doi: 10.18087/cardio.2020.4.n1014
  27. Williams DM, Evans M. Are SGLT-2 Inhibitors the Future of Heart Failure Treatment? The EMPEROR-Preserved and EMPEROR-Reduced Trials. Diabetes Ther. 2020;11(9):1925-34. doi: 10.1007/s13300-020-00889-9
  28. McMurray JJV, Packer M. How Should We Sequence the Treatments for Heart Failure and a Reduced Ejection Fraction?: A Redefinition of Evidence-Based Medicine. Circulation. 20212;143(9):875-7. doi: 10.1161/CIRCULATIONAHA.120.052926
  29. Greene SJ, Fonarow GC, DeVore AD, et al. Titration of Medical Therapy for Heart Failure With Reduced Ejection Fraction. J Am Coll Cardiol. 2019;73(19):2365-83. doi: 10.1016/j.jacc.2019.02.015
  30. Greene SJ, Butler J, Albert NM, et al. Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry. J Am Coll Cardiol. 2018;72(4):351-66. doi: 10.1016/j.jacc.2018.04.070
  31. Schernthaner G, Shehadeh N, Ametov AS, et al. Worldwide inertia to the use of cardiorenal protective glucose-lowering drugs (SGLT2i and GLP-1 RA) in high-risk patients with type 2 diabetes. Cardiovasc Diabetol. 2020;19(1):185. doi: 10.1186/s12933-020-01154-w

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