Real-world insights into empagliflozin use in heart failure across ejection fractions and patients with or without diabetes: a multicenter study from Bangladesh

Empagliflozin, a member of the Sodium-Glucose Co-Transporter 2 (SGLT-2) inhibitor family, is a promising antidiabetic drug with proven benefits in heart failure (HF). However, its effects in heart failure patients in varying ejection fractions with and without diabetes, and its impact in a real-world clinical setting, remain underexplored. This multicenter observational study, conducted in a real-world setting, from November 2022 to October 2023 in four specialized and tertiary care hospitals in Bangladesh. The study included 797 patients diagnosed with heart failure, irrespective of ejection fraction, who received empagliflozin at a dose of 10 mg daily over six months. The primary aim was to evaluate the efficacy and safety of empagliflozin in enhancing clinical, biochemical, and echocardiographic parameters in patients with heart failure across ejection fraction types, with or without diabetes. Of the 797 enrolled patients, 460 (57.7%) had diabetes. Significant improvements were observed in both diabetic and non-diabetic groups across primary and secondary outcomes. Empagliflozin therapy led to improvements in New York Heart Association (NYHA) functional class (p = 0.001), echocardiographic parameters such as left ventricular ejection fraction (LVEF) (p = 0.003), and N-terminal pro–B-type Natriuretic Peptide (NT-proBNP) levels (p < 0.001). Biochemical markers also showed positive changes, including a significant reduction in serum creatinine (p = 0.001) and improvements in estimated Glomerular Filtration Rate (eGFR) (p < 0.001). Subgroup analyses revealed that the therapeutic effects were consistent across different age groups, BMI categories, and longer duration of diabetes. Empagliflozin significantly improved cardiovascular and renal outcomes in heart failure patients, regardless of diabetes status. These findings support the inclusion of empagliflozin in the management of heart failure in clinical practice, particularly for patients with coexisting diabetes or chronic kidney disease. Further large-scale, long-term studies are needed to confirm these results and assess sustained benefits. Not applicable.