Clinical Scorecard: Impact of Empagliflozin on Heart Failure Risk in Overweight Patients: Findings from the Empire Prevent Metabolic Study

At a Glance

Key Highlights

• Empagliflozin significantly reduced estimated extracellular volume (eECV) compared to placebo after 180 days.
• Empagliflozin did not significantly affect epicardial adipose tissue (EAT) mass in the study population.
• Empagliflozin was safe and well tolerated with few reported side effects in non-diabetic overweight or obese patients.

Guideline-Based Recommendations

Diagnosis

• Identify patients aged 60–84 years with BMI > 28 kg/m2 and at least one additional heart failure risk factor (hypertension, ischemic heart disease, previous stroke/TIA, or CKD with eGFR 30–45 mL/min/1.73 m2).
• Exclude patients with known type 2 diabetes or established heart failure.

Management

• Consider empagliflozin 10 mg once daily for 180 days to reduce extracellular fluid volume in high-risk overweight or obese non-diabetic patients.
• Monitor for potential benefits in heart failure prevention through reduction of hypervolemia.

Monitoring & Follow-up

• Assess changes in estimated extracellular volume (eECV) as a surrogate marker for fluid status.
• Monitor epicardial adipose tissue (EAT) mass, although no significant change is expected with empagliflozin in this population.
• Observe for adverse effects and overall safety during treatment.

Risks

• Empagliflozin was generally safe with few side effects reported in the trial population.
• No specific risks identified related to empagliflozin use in non-diabetic overweight or obese patients in this study.

Patient & Prescribing Data

Non-diabetic adults aged 60–84 years with overweight or obesity and additional heart failure risk factors.

Empagliflozin 10 mg daily for 6 months reduces extracellular fluid volume, potentially lowering heart failure risk, without affecting cardiac fat mass.

Clinical Best Practices

• Screen overweight or obese patients without diabetes for heart failure risk factors before initiating empagliflozin.
• Use empagliflozin to target fluid overload as a preventive strategy for heart failure in high-risk populations.
• Monitor patient response through surrogate markers such as eECV and clinical assessment.
• Educate patients on the safety profile and expected outcomes of empagliflozin treatment.

References

• ClinicalTrials.gov NCT05042973