Meta-analysis of DELIVER and EMPEROR-Preserved

SGLT2 inhibitors reduced the risk of cardiovascular death and hospitalisation for heart failure across HFpEF/HFmrEF patient subgroups.

Treatment effects for the studied endpoints were consistently observed in the DELIVER and EMPEROR-Preserved trials

Although there is strong evidence that SGLT2 inhibitors should be used to treat patients with heart failure with reduced ejection fraction (HFrEF), it is not yet well established what the benefits might be for individuals with higher ejection fractions. In the last year, 2 large randomised trials have reported the efficacy of SGLT2 inhibition in HFpEF/HFmrEF: DELIVER (NCT03619213) and EMPEROR-Preserved (NCT03057951).

Dr Muthiah Vaduganathan (Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA) presented a pre-specified meta-analysis combining the DELIVER and EMPEROR-Preserved data, which was simultaneously published in the Lancet 1,2. The primary endpoint for this meta-analysis was time from randomisation to the occurrence of the composite of cardiovascular death or hospitalisation for heart failure.

Combining DELIVER and EMPEROR-Preserved data (total n=12,251) showed that SGLT2 inhibitors reduced composite cardiovascular death or first hospitalisation for heart failure (HR 0.80; 95% CI 0.73–0.87) with consistent reductions in both components: cardiovascular death (HR 0.88; 95% CI 0.77–1.00) and first hospitalisation for heart failure (HR 0.74; 95% CI 0.67–0.83). Adding 3 other trials with HFrEF patients (total n=21,947), SGLT2 inhibitors further reduced the risk of composite cardiovascular death or hospitalisation for heart failure (HR 0.77; 95% CI 0.72–0.82), cardiovascular death (HR 0.87; 95% CI 0.79–0.95), first hospitalisation for heart failure (HR 0.72; 95% CI 0.67–078), and all-cause mortality (HR 0.92; 95% CI 0.86–0.99).

These treatment effects for each of the studied endpoints were consistently observed in both the trials of heart failure with mildly reduced or preserved ejection fraction and across all 5 trials. Treatment effects on the primary endpoint were generally consistent across the 14 subgroups examined, including when stratified by ejection fraction.

  1. Vaduganathan M, et al. A Pre-Specified Meta-Analysis of DELIVER and EMPEROR-Preserved. Hot Line Session 4, ESC Congress 2022, Barcelona, Spain, 26–29 August.
  2. Vaduganathan M, et al. Lancet. 2022 Aug 27. doi: 10.1016/S0140-6736(22)01429-5.