Clinical Outcomes of Empagliflozin in the Treatment of Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

BACKGROUND: Heart failure is reported as common cause of high morbidity and mortality rates globally. Among most used SGLT2i drugs, Empagliflozin has been proven to be effective in reducing cardiovascular mortalities, HF hospitalization, and biomarkers of HF among heart patients. There are limited studies that evaluated the efficacy and safety of empagliflozin for HF patients.

AIMS & OBJECTIVES: The goal of the most recent study was to evaluate the effectiveness of empagliflozin in patients with acute heart failure by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS: The recent systematic review and meta-analysis was conducted by following guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Four Electronic databases were used namely: PubMed, EMBASE, Clinicaltrials.gov and Cochrane library to find research articles. The Cochrane risk of bias tool was applied to assess the risk bias of included RCT’s and the pooled analysis was conducted by using RevMan (Review Manager) software version 5.4.

RESULTS: About 13 RCT’s with 72,871 heart failure (HF) patients were analyzed to compare the effectiveness and safety of empagliflozin with placebo. The pooled analysis favored the experimental group as drug has controlled over first HF hospitalization among heart failure patients (Odds Ratio= 0.67; 0.52 to 0.876 Cl: 95%, p=0.13), total HF hospitalization among heart failure patients as (Odds Ratio=0.55; 0.42 to 0.74 Cl: 95%, p<0.00001), and total adverse events among heart failure patients as (Odds Ratio=0.59; 0.40 to 0.88 Cl: 95%, p<0.00001). However, the levels of LVEF and NT-proBNP were reduced as reported through mean difference of LVEF (Mean difference= 0.41; -0.81 to 1.64 Cl: 95%, p<0.00001) and NT- proBNP among empagliflozin and placebo groups (Mean difference= -1.55; -7.00 to 3.91 Cl: 95%, p<0.00001). CONCLUSION: The findings of recent study reported that empagliflozin, in comparison to placebo, reduced the frequency of first HF hospitalization, total HF hospitalization, and cardiovascular deaths or other adverse events among patients. The levels of LVEF and NT-proBNP were also reduced slightly among group receiving empagliflozin as compared to placebo.