Clinical trial
DAPA-HF & EMPEROR-Reduced
Last updated Sat May 30 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
Design summary
Both trials randomised HFrEF (EF ≤40%) patients on guideline-directed medical therapy to either dapagliflozin 10 mg (DAPA-HF) or empagliflozin 10 mg (EMPEROR-Reduced) vs placebo.
- DAPA-HF: 4,744 patients, median follow-up 18 months.
- EMPEROR-Reduced: 3,730 patients, median follow-up 16 months.
About half of participants did not have type-2 diabetes.
Findings (consistent across both)
- Primary composite (CV death + HF hospitalisation): 25-26% relative reduction.
- CV death: ~14-18% relative reduction.
- HF hospitalisation: ~30% relative reduction.
- Benefit similar in diabetics and non-diabetics.
- Benefit emerged within weeks of starting.
- Safety: low rates of euglycaemic DKA, hypotension, genital infections.
Why it matters
These trials added SGLT2 inhibitors as the fourth pillar of HFrEF treatment alongside ACEi/ARB/ARNi, beta-blockers, and MRAs. Subsequent trials (EMPEROR-Preserved, DELIVER) extended benefit to HFpEF.
The "diabetes drug that treats heart failure" finding reframed SGLT2 inhibitors as cardio-renal drugs with pleiotropic mechanisms beyond glucose lowering.
Related entries
Heart failure, SGLT2 inhibitors, NT-proBNP, EMPA-REG OUTCOME.
References
- McMurray, J. J. V. et al. Dapagliflozin in patients with heart failure and reduced ejection fraction (DAPA-HF). N. Engl. J. Med. 381, 1995–2008 (2019).
- Packer, M. et al. Cardiovascular and renal outcomes with empagliflozin in heart failure (EMPEROR-Reduced). N. Engl. J. Med. 383, 1413–1424 (2020).