Empagliflozin reduces the risk of mortality and hospitalization for heart failure across Thrombolysis In Myocardial Infarction Risk Score for Heart Failure in Diabetes categories: Post hoc analysis of the EMPA‐REG OUTCOME trial

AIM: To investigate the association of the Thrombolysis In Myocardial Infarction (TIMI) Risk Score for Heart Failure in Diabetes (TRS‐HF(DM)) with mortality using data from the EMPA‐REG OUTCOME trial. MATERIALS AND METHODS: In EMPA‐REG OUTCOME, patients with type 2 diabetes and atherosclerotic cardiovascular (CV) disease (N = 7020) received the sodium‐glucose co‐transporter‐2 inhibitor, empagliflozin, 10 or 25 mg or placebo. Post hoc, patients were stratified into risk categories (low‐intermediate, high, very‐high risk scores) using baseline TRS‐HF(DM). Cox regression analyses evaluated the association of TRS‐HF(DM) categories with all‐cause mortality (ACM), CV death, hospitalization for heart failure (HHF) and CV death (excluding fatal stroke) or HHF, and whether empagliflozin reduced the risk of CV outcomes across these risk categories. RESULTS: In placebo patients, increasing risk category was associated with a higher risk of ACM, CV death, and HHF. Empagliflozin reduced the risk of ACM (low‐intermediate HR 0.68 [95% CI 0.48, 0.97] and very‐high 0.69 [0.52, 0.91]), CV death (0.75 [0.48, 1.18] and 0.56 [0.41, 0.78]), HHF (0.53 [0.28, 1.01] and 0.67 [0.48, 0.96]), and CV death or HHF (0.69 [0.46, 1.03]) and (0.64 [0.49, 0.82]) across all risk categories versus placebo. Higher absolute risk reductions (ARRs) were observed for CV death in the very‐high versus low‐intermediate category (P = 0.01). CONCLUSIONS: Applied to EMPA‐REG OUTCOME, higher TRS‐HF(DM) was associated with increased HHF and mortality risk. Empagliflozin reduced CV outcomes across TRS‐HF(DM) categories. Higher ARRs were associated with higher risk scores.