Weight change and clinical outcomes in heart failure with reduced ejection fraction: insights from EMPEROR-Reduced

Anker, S. D. et al. (2023) Weight change and clinical outcomes in heart failure with reduced ejection fraction: insights from EMPEROR-Reduced. European Journal of Heart Failure, 25(1), pp. 117-127. (doi: 10.1002/ejhf.2728) (PMID:36325584)

Abstract

Aims: Baseline body mass index (BMI) and weight loss promoted by sodium-glucose co-transporter 2 inhibitors may impact outcomes in patients with heart failure with reduced ejection fraction (HFrEF). We assessed in the EMPEROR-Reduced population treated with empagliflozin vs placebo the relationship between baseline BMI, weight loss and effects on the primary (time to first hospitalization for heart failure [HHF] or cardiovascular death) and key secondary outcomes. Methods and Results: We categorized patients according to their baseline BMI: <20 kg/m2, (n = 180); 20–<25 kg/m2 (n = 1038); 25–<30 kg/m2 (n = 1345); 30–<35 kg/m2 (n = 774) and ≥35 kg/m2 (n = 393). The treatment effect of empagliflozin on the primary outcome was consistent across all BMI categories (HRs in subgroups 0.66 to 0.88, interaction trend p = 0.32), as was the effect on total (first plus recurrent) HHF (interaction trend p = 0.31). Empagliflozin reduced the rate of eGFR decline consistently across the BMI categories (interaction trend p = 0.67). Overall, incidence rates of any or serious adverse events were comparable between the treatment groups across all BMI categories. Three-hundred-and thirteen (17.4%) of patients treated with empagliflozin experienced a weight loss of more than 5% at week 52 vs. 230 (12.8%) in placebo. When analyzed separately within each treatment group, presence of weight loss was similarly associated with an increased risk of all-cause mortality. Conclusion: The benefits of empagliflozin versus placebo were consistently present across all BMI categories in HFrEF patients. Weight loss was associated with higher risk of all-cause mortality, regardless of treatment group.

• Item Type: Articles
• Additional Information: The EMPEROR-Reduced trial was funded by the Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance.
• Keywords: Empagliflozin, heart failure, BMI, weight loss.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Ferreira, Mr Joao Pedro and Sattar, Professor Naveed
• Authors: Anker, S. D., Khan, M. S., Butler, J., Ofstad, A. P., Peil, B., Pfarr, E., Doehner, W., Sattar, N., Coats, A. J.S., Filippatos, G., Ferreira, J. P., Zannad, F., Pocock, S., and Packer, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: European Journal of Heart Failure
• Publisher: Wiley
• ISSN: 1388-9842
• ISSN (Online): 1879-0844
• Published Online: 02 November 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in European Journal of Heart Failure 25(1): 117-127
• Publisher Policy: Reproduced under a Creative Commons License