Question explored with the scientific record
Jaudiance and heart function
Jardiance cuts heart-failure hospitalizations and helps the heart's filling function. It does not clearly cut cardiovascular death in people with preserved pumping.
For people with heart failure, the hard outcomes are real. In EMPEROR-Reduced, the combined risk of cardiovascular death or heart-failure hospitalization was 19.4% on empagliflozin versus 24.7% on placebo [1][4]. In EMPEROR-Preserved, the combined endpoint fell with a hazard ratio of 0.79 [2]. But the cardiovascular-death component was not significantly reduced in the preserved-ejection-fraction trials [2][3][8]. The benefit is mostly fewer hospitalizations, not longer life.
On heart function itself, the EmDia trial found empagliflozin improved left-ventricular diastolic function (the heart's ability to relax and fill) over 12 weeks, with a change in E/e' of -1.18 [6]. A small 31-patient real-world study saw ejection fraction rise from about 33% to about 39% and right-heart measures improve [5]. That study was nonrandomized and tiny, so treat it as a signal, not proof [5].
| Trial | Population | Primary result |
|---|---|---|
| EMPEROR-Reduced | Reduced EF | 19.4% vs 24.7% events [1] |
| EMPEROR-Preserved | Preserved EF | HR 0.79 [2] |
| DELIVER (dapagliflozin) | Preserved EF | HR 0.82, CV death not significant [3] |
The safety picture in these records is incomplete. The review notes rare ketoacidosis and Fournier gangrene, with no comparator group for the gangrene cases [7]. Long-term safety data beyond the trial windows is not in this retrieval.
My call: for someone with heart failure, the hospitalization benefit is well proven and worth weighing; the mortality benefit is not, especially with preserved pumping. Confidence: moderate.
Sources used 8
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P003. An Evidence Based Quality Improvement Project of the Impact of a Nurse Practitioner Led Heart Failure, Self-Care Focused, Patient Education on Healthcare Related Quality of Life
This study investigates the effects of empagliflozin on cardiovascular and renal outcomes in patients with heart failure, demonstrating a significant reduction in the risk of cardiovascular death and hospitalization for heart failure compared to placebo.
DOI: 10.1016/j.hrtlng.2021.03.058 -
Sglt-2 Inhibitors: A Useful Addition for Treatment of Heart Failure with Mildly Preserved and Preserved Ejection Fraction
A critical review of the role of SGLT2 inhibitors (empagliflozin and dapagliflozin) in heart failure with mildly preserved or preserved ejection fraction (HFpEF/HFpEF), highlighting early CV benefit in EMPEROR-Preserved and DELIVER trials, lack of consistent CV death reduction, …
DOI: 10.31579/2693-4779/114 -
Eficácia dos Inibidores de SGLT2 na Redução de Eventos Cardiovasculares Maiores em Pacientes com Insuficiência Cardíaca com Fração de Ejeção Preservada: Revisão Sistemática de Literatura
Empagliflozin and dapagliflozin reduce major adverse cardiovascular events and heart-failure hospitalizations in HFpEF, with less robust evidence for reducing cardiovascular mortality.
DOI: 10.51473/rcmos.v1i2.2025.1679 -
Use of SGLT-2 Inhibitors in Patients with Chronic Kidney Disease
This CME supplement reviews evidence that SGLT-2 inhibitors reduce heart failure and kidney outcomes in high-risk patients, and summarizes guideline-based guidance for shingles vaccination, asthma, COPD, obesity, aspirin, statins, type 1 diabetes screening, CKD, and CGM.
DOI: 10.12788/jfp.0225 -
Impact of Gliflozins on Right Heart Remodeling in Italian Patients with Type 2 Diabetes and Heart Failure: Results from the GLISCAR Real-World Study
A 12-month real-world study in 31 Italian patients with type 2 diabetes and heart failure with reduced ejection fraction (HFrEF) treated with SGLT2 inhibitors (empagliflozin or dapagliflozin) showed significant improvements in right-ventricular remodeling and pulmonary hemodynam…
DOI: 10.3390/ph18081200 -
Effects of empagliflozin on left ventricular diastolic function in addition to usual care in individuals with type 2 diabetes mellitus—results from the randomized, double-blind, placebo-controlled EmDia trial
In a randomized, double-blind trial (EmDia) in adults with type 2 diabetes and elevated LV filling pressures, adding empagliflozin 10 mg daily to usual care significantly improved left ventricular diastolic function (E/e´) over 12 weeks compared with placebo, with concurrent fav…
DOI: 10.1007/s00392-023-02164-w -
SGLT-hemlar – Nýir meðferðarmöguleikar við langvinnum nýrnasjúkdómi og hjartabilun
This narrative review concludes that SGLT2 inhibitors reduce cardiovascular and renal events in heart failure and chronic kidney disease, with benefits across ejection fractions and diabetes status, while requiring vigilance for rare ketoacidosis and Fournier gangrene.
DOI: 10.17992/lbl.2024.12.817 -
Efficacy of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors in Heart Failure Management: A Narrative Review
This narrative review reports pooled randomized-trial estimates that SGLT2 inhibitors reduce heart failure hospitalizations and cardiovascular mortality overall, with greater benefit in HFrEF and limited HFpEF mortality benefit.
DOI: 10.61919/jhrr.v4i3.1573