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An effective treatment for heart failure with preserved ejection fraction (HFpEF) has remained elusive. Sodium–glucose cotransporter-2 (SGLT-2) inhibitors are on a remarkable winning streak, having shown benefit for patients with diabetes and for patients with heart failure and reduced ejection fraction, regardless of diabetes status. Now, investigators for the manufacturer-sponsored EMPEROR-Preserved trial (NCT03059751) have randomized 5988 patients (mean age, 71 years; 45% women; 76% white; 4% Black) with HFpEF to receive either the SGLT-2 inhibitor empagliflozin or placebo.
All participants had class II–IV heart failure, an ejection fraction >40% (two-thirds with EF >50%), and an N-terminal pro–B-type natriuretic peptide level >300 pg/mL …