NICE has recommended empagliflozin as a clinical and cost-effective option for the treatment of symptomatic chronic heart failure with reduced ejection fraction in adults. The drug is the second SGLT2 inhibitor to be recommended by NICE for this indication, after Forxiga (dapagliflozin).
Empagliflozin has been approved as an add-on to optimised standard care with ACE inhibitors or angiotensin II antagonists, with beta blockers and, if tolerated aldosterone antagonists; or sacubitril/valsartan, with beta blockers, and, if tolerated, aldosterone antagonists.
NICE recommends that treatment is started on the advice of a heart failure specialist, and says that monitoring should be done by the most appropriate healthcare professional.
The recommendation is based on the results of the EMPEROR-Reduced trial, published in 2021. There are currently no trials directly comparing empagliflozin with dapagliflozin, but indirect comparison suggests that empagliflozin is likely to be similar to dapagliflozin in reducing the risk of cardiovascular death or hospitalisation due to heart failure.
Avoidable hospital admissions
Heart failure affects almost one million people in the UK. It is a common cause of unplanned hospital admissions, that are largely preventable and are a significant burden on the NHS, as well as having a detrimental effect on a patients quality of life.
Professor Simon Williams, Past Chair of The British Society for Heart Failure, the professional association for heart failure care in the UK, said: ‘Each year over one million hospital visits in England alone include a heart failure diagnosis as the cause or contributing factor. Heart failure is a complex long term condition, rarely existing in isolation and can be the final destination for a considerable number of cardiovascular diseases. This positive recommendation for empagliflozin by NICE now provides a potentially important new treatment option for adults with symptomatic chronic heart failure with reduced ejection fraction, which may help in avoiding hospitalisations and possibly reduce the growing pressures on our health service.’