Assessing the Real-World Impact of Empagliflozin on Heart Failure with Reduced Ejection Fraction (HFrEF) Outcomes Irrespective of Diabetes Status

Abstract

Objectives: To evaluate the real-world effectiveness of empagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, in reducing rehospitalization and mortality rates among patients with heart failure with reduced ejection fraction (HFrEF), regardless of diabetes mellitus status. Methodology: This prospective observational study was conducted at Dr. Ruth K. M. Pfau Civil Hospital Karachi from October 2023 to March 2024. Data were collected via structured questionnaires capturing demographic characteristics, clinical profiles, and outcomes (rehospitalization and cardiac death). Patients were categorized into two groups: those treated with empagliflozin and those receiving standard care without empagliflozin. Statistical analysis was performed using SPSS version 24, employing descriptive and comparative methods. Results: Of the 140 patients analyzed (65 empagliflozin-treated vs. 75 untreated), the empagliflozin group exhibited significantly lower rates of rehospitalization (9.2% vs. 23%) and cardiac death (4.6% vs. 17.6%) over six months. Renal insufficiency was also markedly reduced in the empagliflozin group (3.1% vs. 23%). Despite a high prevalence of comorbidities, including diabetes (43.1% vs. 44.6%) and hypertension (61.5% vs. 59.5%), empagliflozin consistently improved clinical outcomes across both groups. Conclusion: Empagliflozin significantly reduced rehospitalization and cardiac mortality in HFrEF patients, independent of diabetes status, suggesting its potential to shift heart failure management toward a preventive paradigm. These findings underscore the need for larger, long-term studies to confirm its sustained benefits and broader clinical implications.