Weight change and clinical outcomes in heart failure with reduced ejection fraction: insights from EMPEROR‐Reduced

摘要

ABSTRACT Aims Baseline body mass index (BMI) and weight loss promoted by sodium–glucose cotransporter 2 inhibitors may impact outcomes in patients with heart failure with reduced ejection fraction (HFrEF). We assessed in the EMPEROR‐Reduced population treated with empagliflozin versus placebo the relationship between baseline BMI, weight loss and effects on the primary (time to first hospitalization for heart failure [HHF] or cardiovascular death) and key secondary outcomes. Methods and results We categorized patients according to their baseline BMI: <20?kg/m2 (n?=?180); 20 to <25?kg/m2 (n?=?1038); 25 to <30?kg/m2 (n?=?1345); 30 to <35?kg/m2 (n?=?774) and ≥35?kg/m2 (n?=?393). The treatment effect of empagliflozin on the primary outcome was consistent across all BMI categories (hazard ratios in subgroups 0.66–0.88, interaction trend p?=?0.32), as was the effect on total (first plus recurrent) HHF (interaction trend p?=?0.31). Empagliflozin reduced the rate of estimated glomerular filtration rate decline consistently across the BMI categories (interaction trend p?=?0.67). Overall, incidence rates of any or serious adverse events were comparable between the treatment groups across all BMI categories. A total of 313 (17.4%) patients treated with empagliflozin experienced a weight loss of more than 5% at week 52 versus 230 (12.8%) in placebo. When analysed separately within each treatment group, presence of weight loss was similarly associated with an increased risk of all‐cause mortality. Conclusion The benefits of empagliflozin versus placebo were consistently present across all BMI categories in HFrEF patients. Weight loss was associated with higher risk of all‐cause mortality, regardless of treatment group.