Empagliflozin reduced cardiovascular events and hospitalizations even in malnourished patients with heart failure with reduced ejection fraction. The findings were presented at the European Society of Cardiology Congress 2025.

Malnutrition is common in heart failure with reduced ejection fraction (HFrEF) and is associated with worse outcomes, raising concerns about prescribing therapies that may affect caloric balance. A post-hoc analysis of the EMPEROR-Reduced trial evaluated 3,676 patients, categorizing them using the Controlling Nutritional Status (CONUT) score into malnourished (CONUT ≥2, n=2,039) and not malnourished (CONUT <2).

Over a median follow-up of 14.7 months, malnourished patients had higher risk of cardiovascular death or hospitalization compared with non-malnourished patients (adjusted hazard ratios 1.41 [95% CI, 1.13–1.78] and 1.45 [95% CI, 1.19–1.76], respectively). Empagliflozin lowered the risk of the primary outcome similarly in both groups (hazard ratio 0.73 [95% CI, 0.58–0.92] in malnourished vs 0.78 [95% CI, 0.65–0.92] in non-malnourished, P-interaction = 0.74) and reduced serious adverse events regardless of nutritional status.

These results indicate that malnutrition identifies patients at higher cardiovascular risk, yet empagliflozin remains safe and effective. Clinicians can prescribe empagliflozin confidently in malnourished HFrEF patients to improve outcomes without increasing serious adverse events.