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EMPEROR-Preserved extended the role of SGLT2 inhibition into heart failure with preserved ejection fraction (HFpEF). In more than 5,900 patients with symptomatic heart failure and an ejection fraction above 40%, empagliflozin significantly reduced the composite of cardiovascular death or hospitalization for heart failure compared with placebo. The effect was driven mainly by a reduction in heart-failure hospitalizations, while the benefit was consistent across a wide range of ejection fractions. The trial is important for internists because HFpEF is common, heterogeneous and closely linked to hypertension, obesity, diabetes, chronic kidney disease and atrial fibrillation. Rather than focusing on a single filling-pressure or ejection-fraction number, management increasingly requires attention to the patient's whole cardiometabolic phenotype. SGLT2 inhibitors provide an evidence-based treatment option with benefits extending beyond glucose lowering. Practical implementation still requires attention to volume status, renal function, genital infections and sick-day management. The broader lesson for general medicine is that modern heart-failure therapy is increasingly disease modifying across phenotypes, but treatment remains most effective when comorbidities are recognized and addressed systematically.
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EMPEROR-Preserved extended the role of SGLT2 inhibition into heart failure with preserved ejection fraction (HFpEF). In more than 5,900 patients with symptomatic heart failure and an ejection fraction above 40%, empagliflozin significantly reduced the composite of cardiovascular death or hospitalization for heart failure compared with placebo. The effect was driven mainly by a reduction in heart-failure hospitalizations, while the benefit was consistent across a wide range of ejection fractions. The trial is important for internists because HFpEF is common, heterogeneous and closely linked to hypertension, obesity, diabetes, chronic kidney disease and atrial fibrillation. Rather than focusing on a single filling-pressure or ejection-fraction number, management increasingly requires attention to the patient's whole cardiometabolic phenotype. SGLT2 inhibitors provide an evidence-based treatment option with benefits extending beyond glucose lowering. Practical implementation still requires attention to volume status, renal function, genital infections and sick-day management. The broader lesson for general medicine is that modern heart-failure therapy is increasingly disease modifying across phenotypes, but treatment remains most effective when comorbidities are recognized and addressed systematically.
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