https://orcid.org/0000-0002-2304-6138
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João Pedro Ferreira, Faiez Zannad, Francisco Vasques-Nóvoa, João Sérgio Neves, Gerasimos Filippatos, Stuart J Pocock, Javed Butler, Milton Packer, Stefan D Anker, Anaemia, erythrocytosis, and empagliflozin in heart failure with preserved ejection fraction: the EMPEROR-Preserved trial, European Heart Journal, Volume 46, Issue 11, 14 March 2025, Pages 1074–1077, https://doi.org/10.1093/eurheartj/ehae864
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Introduction
Many patients with heart failure (HF) and a preserved ejection fraction have anaemia as a consequence of ‘chronic disease’. Anaemia worsens HF symptoms and has been associated with poor cardiovascular outcomes.1 Sodium-glucose cotransporter 2 inhibitors (SGLT2i) increase haemoglobin (and haematocrit), often leading to the correction of anaemia and, in some patients, SGLT2i use may lead to erythrocytosis.2–5
While the association of anaemia with poor outcomes has been documented in HF, the association of erythrocytosis with outcomes in HF is less well established.5
The association of anaemia and erythrocytosis with clinical outcomes, the impact of SGLT2i on anaemia and erythrocytosis throughout the follow-up, and the effect of SGLT2i on cardiovascular and kidney outcomes in patients with and without anaemia or erythrocytosis are explored herein using the EMPEROR-Preserved (NCT03057951) data.
Methods
The design and primary results of the EMPEROR-Preserved trial have been published previously.6 The median follow-up was 26.2 months. The primary endpoint was a composite of cardiovascular death or hospitalization for HF. Additionally, the individual components of the primary outcome; a kidney composite outcome of sustained ≥40% estimated glomerular filtration rate decline from baseline, dialysis, transplantation, or end-stage renal disease; a composite of myocardial infarction, stroke, or cardiovascular death; deep vein thrombosis or pulmonary thromboembolism; and all-cause mortality were also studied.
