Trial reportEuropean heart journal2021
Regional and ethnic influences on the response to empagliflozin in patients with heart failure and a reduced ejection fraction: the EMPEROR-Reduced trial.
Trial report in European heart journal, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 55 citations in OpenAlex.
- Prevalence, outcomes and costs of a contemporary, multinational population with heart failure.Heart (British Cardiac Society) · 2023Pooled it
- Geographic region variation in patient characteristics, clinical outcomes and treatment of HFrEF in the VICTORIA trial.ESC heart failure · 2025Trial
- Anaemia predicts iron homoeostasis dysregulation and modulates the response to empagliflozin in heart failure with reduced ejection fraction: the EMPATROPISM-FE trial.European heart journal · 2025Trial
- Association of time-to-intravenous furosemide with mortality in acute heart failure: data from REPORT-HF.European journal of heart failure · 2023Trial
- Prediction of incident heart failure in type 2 diabetes mellitus: Rationale and design of the DM-HEART study.Journal of diabetes investigation · 2026Article
- Heart failure with preserved ejection fraction: current insights and emerging therapeutic directions.The Korean journal of physiology & pharmacology : official journal of the Korean Physiological Society and the Korean Society of Pharmacology · 2026Review
- Understanding Geographic Variations in Heart Failure Clinical Trials.Current heart failure reports · 2026Review
- Heart Failure in Asian Populations.JACC. Asia · 2025Article
- Consistency of HFrEF treatment effect in underrepresented groups in randomized clinical trials.NPJ cardiovascular health · 2024Review
- How to make cardiology clinical trials more inclusive.Nature medicine · 2024Review
- Epidemiology and Burden of Heart Failure in Asia.JACC. Asia · 2024Review
- Effects of Dapagliflozin in Patients in Asia: A Post Hoc Subgroup Analysis From the DELIVER Trial.JACC. Asia · 2024Article
- Sodium-Glucose Cotransporter-2 Inhibitors in Heart Failure: Role of Regional/Ethnic Differences: Focus on Asia.JACC. Asia · 2024Article
- Cardiovascular outcomes trials: a paradigm shift in the current management of type 2 diabetes.Cardiovascular diabetology · 2022Review
- Efficacy and Safety of Dapagliflozin in Patients With CKD Across Major Geographic Regions.Kidney international reports · 2022Article
- The year in cardiovascular medicine 2021: heart failure and cardiomyopathies.European heart journal · 2022Article
Corrections and comments
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Authors and funding
16 authors at 13 institutions in 9 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsThe aim of this article is to explore the influence of region and race/ethnicity on the effects of empagliflozin in the Empagliflozin Outcome Trial in Patients with Chronic Heart Failure and a Reduced Ejection Fraction (EMPEROR-Reduced) trial. METHODS AND
resultsOf 3730 patients, 1353 (36.3%) were enrolled in Europe, 1286 (34.5%) in Latin America, 425 (11.4%) in North America, and 493 (13.2%) in Asia; 2629 (70.5%) were White, 257 (6.9%) Black, and 672 (18.0%) Asian. Placebo event rates (per 100 patient-years) for cardiovascular death or heart failure (HF) hospitalization varied by region (Asia 27.7, North America 26.4, Latin America 21.4, and Europe 17.5) and race/ethnicity (Black 34.4, Asian 24.3, and White 18.7); driven by differences in HF hospitalization. The ratio of total HF hospitalization to cardiovascular death varied from 5.4 in Asia and 4.8 in North America to 2.1 in Europe; and from 4.8 in Black and 4.2 in Asian to 2.2 in White patients. Groups with the highest ratio had the greatest reduction in the primary outcome with empagliflozin. Inclusion of outpatient worsening HF episodes added more events in Europe vs. other regions; enhanced the placebo event rates in Europe vs. other regions; and increased the relative risk reduction with empagliflozin in Europe from 6% to 26%.
conclusionsThere were notable differences in the placebo event rates for major HF events across diverse regions and race/ethnic groups. The benefit of empagliflozin was most pronounced in groups with the highest ratio of HF hospitalization to cardiovascular death. Regional differences were attenuated when the definition of HF events was expanded to include outpatient worsening HF events.
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