Meta-analysis of DELIVER and EMPEROR-Preserved

In a meta-analysis of SGLT2 inhibitors in heart failure patients with preserved or mildly reduced ejection fraction (HFpEF/HFmrEF), reduced risk of cardiovascular death and hospitalisation for HF was observed across patient subgroups, supporting their role as a foundational therapy for HF, irrespective of EF.

Although there is strong evidence that SGLT2 inhibitors should be used to treat patients with heart failure with reduced ejection fraction (HFrEF), it is not yet well established what the benefits might be for individuals with higher EF. In the last year, 2 large randomised phase 3 trials have reported the efficacy of SGLT2 inhibition in HFpEF/HFmrEF: DELIVER (NCT03619213) and EMPEROR-Preserved (NCT03057951). Dr Muthiah Vaduganathan (Brigham and Women's Hospital, Harvard Medical School, MA, USA) presented a pre-specified meta-analysis combining the DELIVER and EMPEROR-Preserved data, which was simultaneously published in the Lancet [1,2]. The primary endpoint for this meta-analysis was time from randomisation to the occurrence of the composite of cardiovascular death or hospitalisation for HF.

Combining DELIVER and EMPEROR-Preserved data (total n=12,251) showed that SGLT2 inhibitors reduced composite cardiovascular death or first hospitalisation for HF (HR 0.80; 95% CI 0.73–0.87; P<0.0001) with reductions in both components: cardiovascular death (HR 0.88; 95% CI 0.77–1.00; P=0.052) and first hospitalisation for HF (HR 0.74; 95% CI 0.67–0.83; P<0.0001). Adding 3 other trials with HFrEF patients (total n=21,947), SGLT2 inhibitors further reduced the risk of composite cardiovascular death or hospitalisation for HF (HR 0.77; 95% CI 0.72–0.82), cardiovascular death (HR 0.87; 95% CI 0.79–0.95), first hospitalisation for HF (HR 0.72; 95% CI 0.67–078), and all-cause mortality (HR 0.92; 95% CI 0.86–0.99). These treatment effects for each of the studied endpoints were consistently observed in both the trials of HFmrEF/HFpEF and across all 5 trials. Treatment effects on the primary endpoint were generally consistent across the 14 subgroups examined, including when stratified by EF.

1. Vaduganathan M, et al. A Pre-Specified Meta-Analysis of DELIVER and EMPEROR-Preserved. Hot Line Session 4, ESC Congress 2022, Barcelona, Spain, 26–29 August.
2. Vaduganathan M, et al. Lancet. 2022 Aug 27. doi: 10.1016/S0140-6736(22)01429-5.

 

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Posted on 27 October 202226 October 2022