1 Recommendations

1.1 Empagliflozin is recommended, within its marketing authorisation, as an option for treating symptomatic chronic heart failure with preserved or mildly reduced ejection fraction in adults.

1.2 If people with the condition and their clinicians consider empagliflozin to be 1 of a range of suitable treatments (including dapagliflozin), after discussing the advantages and disadvantages of all the options, use the least expensive. Take account of administration costs, dosage, price per dose and commercial arrangements.

Why these recommendations were made

Chronic heart failure with preserved or mildly reduced ejection fraction is usually treated with standard care (loop diuretics, and treatment for other conditions the person may have). People may also have dapagliflozin which is already recommended in NICE's technology appraisal guidance on dapagliflozin. Empagliflozin works in a similar way to dapagliflozin and would be offered to the same population.

Evidence from a clinical trial shows that empagliflozin plus standard care reduces the combined risk of dying from cardiovascular causes or likelihood of first hospitalisation for heart failure compared with placebo plus standard care. There is no clinical trial evidence directly comparing empagliflozin with dapagliflozin. The trials for empagliflozin and dapagliflozin have some differences, including the populations included in the trials and how outcomes are defined. When adjustments for these differences are made, an indirect comparison suggests the treatments have similar clinical effectiveness and a similar effect on quality of life.

A cost comparison suggests empagliflozin has similar costs to dapagliflozin. So, empagliflozin is recommended. Empagliflozin should be started on the advice of a heart failure specialist.

For all evidence see the committee papers. To see what NICE did for dapagliflozin, see the committee discussion section in NICE's technology appraisal guidance on dapagliflozin.