Empagliflozin vs. dapagliflozin in heart failure: a target trial emulation
Abstract
BACKGROUND
No randomized trial has compared head-to-head the effects of empagliflozin and dapagliflozin in patients with heart failure.
METHODS
This nationwide, prospective, new-user, active-comparator cohort study emulated a pragmatic target trial comparing heart failure rehospitalization and all-cause death risks in adults with heart failure initiating empagliflozin vs. dapagliflozin. In effect of initiating and sustained treatment analyses, we calculated one and five-year risks and risk ratios (RRs) of outcomes. Follow-up began at treatment initiation (June 1, 2014-December 31, 2022) and continued until the first of an outcome, emigration, December 31, 2022, or five years of follow-up. Inverse probability of treatment and censoring weights were applied to balance baseline covariates and, in analyses of sustained treatment, to account for nonadherence.
RESULTS
2,860 patients initiated empagliflozin and 6,264 initiated dapagliflozin (median age, 70 [IQR, 61-78] years; 25% females). In effect of initiating treatment analyses, heart failure rehospitalization risks at one year were 16.1% in the empagliflozin group vs. 19.8% in the dapagliflozin group (RR, 0.81 [95% CI, 0.71-0.94]) and 30.5% vs. 33.4% at five years (RR, 0.92 [95% CI, 0.79-1.06]). The risks of all-cause death were 6.7% vs. 6.9% at one year (RR, 0.97 [95% CI, 0.74-1.27]) and 23.4% vs. 23.8% at five years (RR, 0.98 [95% CI, 0.77-1.25]). In the effect of sustained treatment analyses, the RRs for heart failure…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 2,860 participants or records.
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