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Am Fam Physician. 2022;105(4):online

Clinical Question

Does empagliflozin (Jardiance), a sodium-glucose cotransporter-2 inhibitor, safely improve outcomes for patients who have heart failure with preserved ejection fraction?

Bottom Line

In patients who have heart failure with preserved ejection fraction, empagliflozin, 10 mg once daily, reduces the likelihood of hospitalization for heart failure (number needed to treat = 59 per year). There is no effect on cardiovascular or all-cause mortality. The drug costs $529 per month in the United States (www.goodrx.com; accessed October 30, 2021) and $82 per month in Canada (https://www.formulary.health.gov.on.ca/formulary; accessed October 30, 2021). In the United States, the drug is not cost-effective, and would require $375,000 to prevent one hospitalization; in Canada, that cost is $58,000. (Level of Evidence = 1b)

Synopsis

This industry-sponsored trial identified patients with New York Heart Association Class II through IV heart failure, an ejection fraction of at least 40%, and an N-terminal pro-brain natriuretic peptide (NT pro-BNP) level of more than 300 pg per mL (more than 900 pg per mL if the patient had atrial fibrillation). Of the 11,583 patients at 622 centers in 23 countries who were screened for the trial, 5,988 were randomized to receive empagliflozin, 10 mg once daily, or placebo. The primary reason for exclusion was failure to meet the NT pro-BNP target.

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POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see https://www.essentialevidenceplus.com/Home/Loe?show=Sort.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Natasha J. Pyzocha, DO, contributing editor.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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