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EMPEROR-Reduced Trial — EECC MCQ

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EasyHeart FailureEMPEROR-Reduced TrialEECC

A medical student asks about the EMPEROR-Reduced trial. What was the primary finding and how did it change HF guidelines?

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Reveal the answer and explanation

Correct answer: A — Empagliflozin reduced the composite of cardiovascular death or HF hospitalisation by 25% in HFrEF patients, regardless of diabetes status — leading to the Class I recommendation for SGLT2 inhibitors as a fourth pillar of GDMT

EMPEROR-Reduced (2020) randomised 3,730 patients with HFrEF (LVEF ≤40%, NYHA II-IV, elevated NT-proBNP) to empagliflozin 10 mg vs placebo, on top of guideline-directed therapy. It demonstrated a 25% relative risk reduction in the composite of CV death or first HF hospitalisation (driven primarily by HF hospitalisation reduction). Crucially, approximately 50% of patients did not have diabetes, and the benefit was consistent regardless of diabetes status. Together with DAPA-HF (dapagliflozin), this established SGLT2 inhibitors as the fourth pillar of GDMT for HFrEF alongside ACEi/ARNI, beta-blocker, and MRA. The 2023 ESC HF Focused Update gave SGLT2 inhibitors a Class I recommendation across all EF ranges.

Reference: ESC (2023): HF Guidelines; EMPEROR-Reduced Trial