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EMPEROR-Preserved vs DELIVER — EECC MCQ

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ModerateHeart FailureEMPEROR-Preserved vs DELIVEREECC

A 65-year-old woman with HFpEF and obesity is started on empagliflozin. The EMPEROR-Preserved trial is discussed. What was the primary finding and how did it differ from DELIVER?

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Correct answer: E — EMPEROR-Preserved showed empagliflozin reduced the composite of CV death or first HF hospitalisation by 21% in HFpEF (LVEF >40%); DELIVER showed dapagliflozin reduced the same composite by 18% — together establishing SGLT2i as Class I for HF across ALL EF ranges

EMPEROR-Preserved (2021) and DELIVER (2022) were the landmark trials establishing SGLT2i efficacy in HFpEF/HFmrEF: EMPEROR-Preserved: empagliflozin in LVEF >40% (n=5,988) → 21% RRR composite of CV death or HF hospitalisation (HR 0.79); driven by HF hospitalisation reduction. DELIVER: dapagliflozin in LVEF >40% (n=6,263) → 18% RRR same composite (HR 0.82); also driven by HF hospitalisation. Key features: (1) both included diabetic and non-diabetic patients with consistent benefit; (2) both included patients with recently reduced LVEF that had improved >40% (HF with improved EF); (3) the pooled analysis across DAPA-HF + DELIVER + EMPEROR-Reduced + EMPEROR-Preserved confirmed consistent benefit across the entire EF spectrum. The 2023 ESC HF Focused Update gave SGLT2i a Class I recommendation for ALL HF (HFrEF, HFmrEF, HFpEF).

Reference: ESC (2023): HF Focused Update; EMPEROR-Preserved/DELIVER