Abstract 10399: Population-Level Implications of Empagliflozin for Heart Failure With Preserved Ejection Fraction in the United States

Abstract

Introduction: The indication for empagliflozin has been expanded to patients with heart failure (HF) and left ventricular ejection fraction (LVEF) >40% after findings of significant reduction in HF hospitalizations (HFH) and cardiovascular mortality (CVM) in the EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction) trial. Objective: To quantify the estimated United States population-level impact of reducing worsening HF events with empagliflozin in LVEF >40%. Methods: A projected adult HF population (age >18) eligible for empagliflozin, obtained using weighted data from the National Health and Nutritional Examination Survey (2015-2018) was mapped onto newly eligible LVEF distributions, >40% overall and those >40% to 65% from the Get With The Guidelines Heart Failure registry. Number needed to treat (NNT) at 3 years for worsening HF events (urgent HF visits, total HFH and CVM) and total HFH, were calculated using rate difference from the EMPEROR program to estimate population-level treatment effects. Results: A projected 4,794,524 adults with HF are eligible for empagliflozin therapy. The population was predominantly male (57%) and white (67%), with a mean age of 66 years. Of this total population, 2,619,248 would be estimated as newly eligible with LVEF >40% and 2,310,960 with LVEF >40% to 65%. A projected 923,426 (95% CI, 769,893 – 1,076,959) worsening HF events would be prevented across the LVEF spectrum with empagliflozin over 3 years, out of which 301,738 (95%CI: 251,570, 351,906) and 295,341 (95%CI: 246,236 – 344,446) would be prevented in LVEF >40% and LVEF >40% to 65% subgroups, respectively. Moreover, an estimated 614,179 (95% CI, 512,063 – 716295) total HFH events would be prevented across the LVEF spectrum, out of which 201,159 (95%CI: 167,713 – 234,604) and 218,386 (95%CI: 182,076 – 254,696) total HFH events would be prevented in LVEF >40% and LVEF >40% to 65% subgroups, respectively. Conclusions: In addition to the proven benefit in HF with LVEF ≤40%, optimal implementation of empagliflozin in the US for treatment of HF with LVEF >40% has the potential to prevent/postpone an additional 300,000 worsening HF events over 3 years.