Thread by @cardiomet_CE

1)
... more from the #ESCCongress2021 from the @GoggleDocs #Takeover of the @cardiomet_CE

Next up the EMPEROR-Pooled analysis and some of the questions it asks

How does empagliflozin compare with ARNI (sacubitral/valsartan

2)
EMPEROR-Pooled was a prespecified analysis of the two 'sister' studies

EMPEROR-Reduced Trial
nejm.org/doi/full/10.10…

and

EMPEROR-Preserved Trial
nejm.org/doi/full/10.10…

With very similar #HeartFailure populations, separated by an ejection fraction cut off of 40%

3)

As you can see

📍Very similar results in terms of the primary and secondary #HeartFailure outcomes.

‼️ Although clear attenuation of benefit seen in pople with higher ejection fractions (EF)

4)

‼️Benefits in terms of the risk of hospitalisation for heart failure appear to be consistent below an EF of 65%

⚠️Currently this drug is only licensed if EF <40%

🤞This will change soon, as many people with #HeartFailure have an EF 40-65% (elderly & #type2diabetes)

5)
How does this attenuation of benefits compare in other #HeartFailure studies?

🥇 empagliflozin benefits people if EF<65%

🥈sacubitril/valsartan may benefit if <EF62.5%

🥉spironolactone may benefit if EF<60%

6)

How does this compare to ARNI (sacubitril/valsartan)?

Milton Packer gives us his thoughts

⚠️No direct comparison undertaken

✅empagliflozin appears to have a greater magnitude of benefit than sacubitril/valsartan at all EF categories

7)

What about the #kidney benefits?

⚠️Both studies were not renal outcome studies

‼️Composite renal outcomes differ between studies.

‼️ Using a different composite we can see similar attenuation of benefits of empagliflozin on Kidney outcomes as we see with #HeartFailure

9) In Conclusion

empagliflozin 10mg in people with #HeartFailure

1) ⤵️🏥💔+CV☠️ in both "HFrEF" & "HFpEF"

2) outcomes driven by ⤵️🏥💔

3) No benefits seen if EF>65

4) Kidney benefits may be similarly attenuated at higher EF