Portal de investigação
Mineralocorticoid Receptor Antagonists and Empagliflozin in Patients With Heart Failure and Preserved Ejection Fraction
Data de publicação:
Data Ahead of Print:
Autores da FMUP
Participantes de fora da FMUP
- Butler, J
- Zannad, F
- Filippatos, G
- Schueler, E
- Steubl, D
- Zeller, C
- Januzzi, JL
- Pocock, S
- Packer, M
- Anker, SD
Unidades de investigação
Abstract
BACKGROUND Mineralocorticoid receptor antagonists (MRAs) may be beneficial in reducing heart failure (HF) hospitalizations in patients with HF with preserved ejection fraction. The effect of sodium-glucose cotransporter 2 inhibitors in patients with HF with preserved ejection fraction according to MRA background therapy has not been reported. OBJECTIVES The aim of this study was to examine the effect of empagliflozin in MRA users and nonusers in the EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction) trial. METHODS Survival analyses were conducted comparing the effects of empagliflozin vs placebo in MRA users and nonusers at baseline with treatment-by-MRA use interaction terms. RESULTS A total of 5,988 patients were included, of whom 2,244 (37.5%) were using MRAs at baseline. MRA users had higher event rates than MRA nonusers (placebo group primary outcome 9.4 vs 8.2 events per 100 person-years). The benefit of empagliflozin to reduce the primary outcome was not significantly different between MRA nonusers and MRA users (HR: 0.73 [95% CI: 0.62-0.87] and HR: 0.87 [95% CI: 0.71-1.06]; interaction P = 0.22). The effect of empagliflozin to reduce first and recurrent HF hospitalizations was more pronounced in MRA nonusers than in MRA users (HR: 0.60 [95% CI: 0.47-0.77] and HR: 0.90 [95% CI: 0.68-1.19]; interaction P = 0.038). MRA users experienced almost twice as many hyperkalemia events as MRA nonusers, and empagliflozin reduced the risk for hyperkalemia or initiation of potassium binders regardless of MRA use (MRA nonusers: HR: 0.90 [95% CI: 0.69-1.19]; MRA users: HR: 0.74 [95% CI: 0.56-0.96]; interaction P = 0.29). CONCLUSIONS The benefit of empagliflozin to reduce the primary outcome was not significantly different between MRA nonusers and MRA users. The effect of empagliflozin to reduce first and recurrent HF hospitalizations was more pronounced in MRA nonusers. Empagliflozin reduced hyperkalemia, with no significant treatment-by-MRA subgroup interaction. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
Dados da publicação
- ISSN/ISSNe:
- 1558-3597, 0735-1097
- Tipo:
- Article
- Páginas:
- 1129-1137
- Link para outro recurso:
- www.scopus.com
Journal of the American College of Cardiology Elsevier USA
Citações Recebidas na Web of Science: 38
Citações Recebidas na Scopus: 43
Documentos
- Não há documentos
Filiações
Keywords
- empagliflozin; heart failure with preserved ejection fraction; hyperkalemia; mineralocorticoid receptor antagonists; treatment effect
Financiamento
Proyectos asociados
Dapagliflozin, Spironolactone or Both for HFpEF (SOGALDI-PEF) - NCT05676684
Investigador Principal: João Pedro Melo Marques Pinho Ferreira
Ensaio Clínico Académico (SOGALDI-PEF) . AstraZeneca . 2022
Citar a publicação
Ferreira J,Butler J,Zannad F,Filippatos G,Schueler E,Steubl D,Zeller C,Januzzi JL,Pocock S,Packer M,Anker SD. Mineralocorticoid Receptor Antagonists and Empagliflozin in Patients With Heart Failure and Preserved Ejection Fraction. J. Am. Coll. Cardiol. 2022. 79. (12):p. 1129-1137. IF:24,000. (1).
