Thread by @cardiomet_CE

1) Welcome to a new joint-accredited #tweetorial on the highlights of cutting-edge #cardiometabolic research from this years #ESCCongress. We are
@GoggleDocs. Follow this tweetorial to earn FREE 0.75h credit, #physicians #nurses #pharmacists!
@MedTweetorials
#FOAMed #medtwitter

2) This program is intended for healthcare professionals and is supported by educational grants from AstraZeneca, Bayer, Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company, Chiesi, and NovoNordisk. See archived programs at cardiometabolic-ce.com.

3) Over the next 3 days the @GoggleDocs will be #Takeover with @cardiomet_CE account.

We are four 🇬🇧 based doc working across healthcare.

Our interests are "what's new, and meaning full in cardio-renal metabolic medicine"

Check out our YouTube channel youtube.com/c/GoggleDocs

4) The #ESCCongress2021 was again an online only event.

Live between 27th to 30th August 2021

We will be covering what's new in

✅SGLT2i's in Heart failure (particularly EMPEROR-Preserved results)
✅Heart Failure Guidelines
✅Finerenone
✅Hypertension
✅Much, much, more

5) So let's start today with the EMPEROR-Preserved Trial

📍🥇 fully-completed large RCT using SGLT2i in people with ejection fraction (EF) >40% to report
📍10mg empagliflozin vs placebo
📍in people with and without #type2diabetes
📍NYHA class II-IV
📍mean follow-up 26 months

6) So what was the population studied?

📍Approximately 2/3 had an ejection fraction on echo of 40-50% (ESC 'mildly-reduced' range)
📍82% NYHA class II
📍45%♀️
📍51% had #atrialfibrillation
📍half had reduced kidney function

7) WOW‼️

Treatment with empagliflozin 10mg gave us this

Primary outcome (composite of 🏥💔 plus CV☠️)
⤵️21% relative risk reduction (29% ⤵️🏥💔)
⤵️3.3% absolute risk reduction
📍NNT of 30❗️
📍Benefits seen within 18 days 👏👏👏

⚠️only a non-sig ⤵️ in Cardiovascular death

8) So let's do some digging into this data

9) Benefits seen in all sub-groups

📍No difference regardless of presence of #type2diabetes

📍No difference age, gender, baseline renal function & background therapy

⚠️Benefits attenuated at higher EFs (more on this later today)

10) Key secondary outcomes

27%⤵️ Total (1st and recurrent) 🏥💔

⤵️Renal function decline (i.e. some preservation of kidney function)❗️

📍no change in All-Cause☠️
📍although CV☠️ was only half of causes of death in this study

11) What about Quality of Life and functional capacity?

Statistically significant ⤴️ Quality of life (as measured by KCCQ score)

⤴️ in average functional capacity

📍Bottom-line. Small but statistically significant improvements seen in both parameters

12) ⚠️ADVERSE EFFECTS⚠️

✅well tolerated overall

✅No increase in Hypoglycaemia, ketoacidosis, bone fractures and lower limb amputations
⚠️⤴️Hypotension (NNH=55)
⚠️⤴️genital infections (NNH=66)

13) In Conclusion!

✅🥇 RCT to show prognostic benefits in #HeartFailure with EF>40%

📍empagliflozin 10mg
✅⤵️🏥💔 & CV☠️ (NNT 30)
✅recurrent ⤵️🏥💔
✅some kidney function preservation
✅some ⤴️ in quality of life & function
🤔 no change in all-cause☠️
✅Well tolerated

14) What SGLT2i ('flozin') was used in the EMPEROR Preserved Trial?

15) Benefits in the primary endpoint were seen in...

16) Keep Tuned

More from #ESCCongress #ESCCongress2021 coming very soon.

Next up with be some insights from EMPEROR-Pooled analysis❗️

Do need to change the EF classification of #HeartFailure ❓

How does empalgliflozin outcomes compare to ARNI or spironolactone based therapy❓