Benefits of Empagliflozin in Patients With Heart Failure and Reduced Ejection Fraction Without Diabetes Mellitus

Inclusion Criteria: * Ambulatory non-diabetic adult male and non-pregnant female patients with established diagnosis of heart failure (HF) New York Heart Association functional class II-IV and left ventricular ejection fraction (LVEF) ≤ 40% (calculated by echocardiography within the previous 6 months before randomization). * Patients should have stable symptoms and stable guideline-directed medical therapy for HF within the last 3 months before randomization. It was mandatory that all patients have reached the maximum tolerated doses of guideline-directed medical therapy for HF and are regular on them for at least 3 months before participation. * Patients were not known to be diabetic and have no history of diabetes remission and their baseline glycosylated hemoglobin (HbA1c) should have been \< 5.7%. * Patients have never been on SGLT2 inhibitor therapy before. * Estimated glomerular filtration rate (eGFR) should have been ≥ 45 mL/min/1.73 m² using the chronic kidney disease Epidemiology Collaboration (CKD-EPI) creatinine equation (2009) Exclusion Criteria: * Women who were pregnant at time of selection, possibly pregnant, breast-feeding, or planning to become pregnant during the study period. * Patients who had acute coronary syndrome, cardiac surgery, stroke or transient ischemic attack (TIA) within the last 3 months before randomization. * Patients who had infiltrative cardiomyopathy, muscular dystrophies, hypertrophic cardiomyopathy, peripartum cardiomyopathy, pericardial restriction or chemotherapy induced cardiomyopathy within 12 months before randomization. * Patients with severe valvular heart disease. * Patients who had acute decompensated HF or were on continuous parenteral inotropic agents with 3 months before randomization. * Patients who had cardiac resynchronization therapy (CRT) implantation within 3 months before randomization. * History of recurrent urinary tract infection, cancer or any life threatening condition or psychiatric disease incompatible with being in the study.