Recently, Mone et al. (1) reported that the sodium–glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin improves cognitive and physical impairment in frail older adults with diabetes and heart failure with preserved ejection fraction (HFpEF). The latest guideline from the American Heart Association, American College of Cardiology, and Heart Failure Society of America (2) recommends, in patients with heart failure and type 2 diabetes, the use of SGLT2i for the management of hyperglycemia and to reduce heart failure–related morbidity and mortality. The guideline also states that in patients with HFpEF, SGLT2i can be beneficial in decreasing heart failure hospitalizations and cardiovascular mortality.

EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction) enrolled 5,988 patients with HFpEF with and without type 2 diabetes. The primary outcome was hospitalization for heart failure or cardiovascular mortality. The results indicated that empagliflozin reduced hospitalization for heart failure by 27% and cardiovascular mortality by 11% (3). EMPEROR-Preserved also demonstrated that empagliflozin improved health-related quality of life (4), which seems to coincide with the findings from Mone et al. (1). Previous studies have mostly focused on the cardiovascular benefits of empagliflozin in patients with diabetes and HFpEF (5), and previous quality-of-life–based assessments were also derived from post hoc analyses. This study is the first to directly assess the cognitive status of empagliflozin in such elderly patients, with encouraging results. This is direct and strong evidence that empagliflozin improves health-related quality of life.

See accompanying article, p. e151.

Acknowledgments. The authors thank all scientists and participants involved in research on empagliflozin and heart failure.

Duality of Interest. No potential conflicts of interest relevant to this article were reported.

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