Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) are widely used to improve outcomes in heart failure (HF). A cohort study published in JAMA Network Open compared the clinical effectiveness of dapagliflozin and empagliflozin in adults with HF.

After one-to-one propensity score matching, 4,930 patients were included, with 2,465 receiving dapagliflozin and 2,465 receiving empagliflozin. The mean age was 68.8 years, and 59.7% were male. The median follow-up was 16.0 months (interquartile range 8.0–27.0 months). Participants were stratified by left ventricular ejection fraction (LVEF) into HF with reduced ejection fraction (LVEF ≤40%), mildly reduced ejection fraction (LVEF 41–49%), and preserved ejection fraction (LVEF ≥50%).

The primary composite outcome of cardiovascular death or hospitalization for HF occurred in 9.8% of dapagliflozin users vs 9.3% of empagliflozin users (adjusted hazard ratio 0.99; 95% CI 0.83–1.19; P = .95). No significant differences were observed across LVEF categories, including HF with reduced (14.9% vs 15.4%), mildly reduced (5.0% vs 6.3%), and preserved ejection fraction (7.7% vs 6.0%). All secondary outcomes, including all-cause mortality and cardiovascular hospitalization, also showed no between-group differences.

These findings suggest that dapagliflozin and empagliflozin provide similar effectiveness in HF management across the ejection fraction spectrum. Ongoing studies may clarify whether specific clinical features support individualized therapy selection.