Dapagliflozin versus empagliflozin in patients with heart failure with preserved ejection fraction

Current guidelines for managing heart failure with preserved ejection fraction (HFpEF) focus on controlling volume overload as needed and adding an SGLT-2 inhibitor. Because SGLT-2 inhibitors are thought to have a class effect in treating HFpEF, there is no consensus on a preferred agent, and existing studies often yield conflicting results. In this study, we aimed to compare dapagliflozin (DAP, 10mg once daily) and empagliflozin (EMP, 10mg once daily) for the management of HFpEF.

We conducted a retrospective cohort analysis of deidentified, aggregate patient data from the TriNetX research network. Patients aged ≥18 years with a diagnosis of HFpEF (ICD-10 codes: I50.3x or I50.4x with an LVEF >=50%) between January 2018 and January 2022 were identified. Patients were then divided into two groups based on whether they received DAP or EMP. Following a tight 1:1 propensity score matching for baseline demographics, prescribed medications, comorbidities, LVEF, baseline HgbA1c and NT-proBNP/BNP levels we calculated odds ratios and Cox proportional hazards ratios to compare outcomes over a two-year follow-up period. Primary outcomes included all-cause mortality and acute decompensated HF (defined by ICD codes or need for IV diuretics). Secondary outcomes included HgbA1c change and incidence of UTI or diabetic ketoacidosis (DKA).

The matched cohort included 10,672 patients with HFpEF (5,336 per group; mean age 70.4 years; 53.4% female; 69% White; mean LVEF 61.8%). All-cause mortality did not differ significantly between the two groups (DAP: 8.25% vs. EMP: 8.28%; OR: 0.995 [95% CI: 0.86–1.14]; P=0.94). The risk of acute decompensated HF was also similar (DAP: 25.5% vs. EMP: 24.5%; OR: 1.05 [95% CI: 0.95–1.17]; P=0.97). The change in HbA1c did not differ significantly between the two groups (DAP: -0.152% vs. EMP: -0.101%; P=0.341). Likewise, the incidence of UTI/DKA was comparable (DAP: 13.5% vs. EMP: 12.7%; OR: 1.07 [95% CI: 0.95–1.21]; P=0.25). Time-to-event analysis of primary outcomes is depicted in Figure 1.

In this retrospective cohort of HFpEF patients, dapagliflozin and empagliflozin showed similar efficacy and safety profiles supporting the notion of a class effect among SGLT-2 inhibitors for HFpEF management.

Time-to-event analysis of outcomes