EMPEROR-Preserved Benefit Stratification Index

EMPEROR-Preserved Benefit Stratification Index — Explanation and Clinical Context This tool is an approximate, transparent calculator that estimates the expected absolute benefit (absolute risk reduction and number-needed-to-treat) from empagliflozin for the EMPEROR-Preserved primary composite outcome (cardiovascular death or first hospitalization for heart failure) over a follow-up period consistent with the trial (median 26.2 months). The EMPEROR-Preserved randomized trial (n=5,988) reported a primary outcome occurrence of 17.1% in the placebo group and 13.8% in the empagliflozin group over a median follow-up of 26.2 months, corresponding to a hazard ratio (HR) of 0.79 (95% CI, 0.69–0.90). The trial benefit was driven primarily by fewer heart failure hospitalizations.

This calculator either accepts a clinician’s measured estimate of a patient’s baseline 2.2-year risk (preferred) or produces a pragmatic baseline risk estimate by adjusting the trial placebo rate with simple multipliers for common risk markers (age, LVEF, diabetes status, eGFR, recent HF hospitalization). These multipliers are intentionally conservative and approximate — they are not a fully validated prognostic model. The treated risk is then estimated by applying the trial HR (0.79) to the baseline risk to produce an estimated treated cumulative incidence; ARR and NNT are calculated from those values.

Use these outputs as an aid to shared decision-making and resource prioritization; they are not a substitute for individualized clinical assessment or a replacement for validated risk models tailored to a patient cohort. References Anker SD, Butler J, Filippatos G, et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction.

N Engl J Med. 2021;385:1451–1461. (Primary EMPEROR-Preserved trial; reported primary outcome: placebo 17.1% vs empagliflozin 13.8%; HR 0.79). Filippatos G, Butler J, et al.

Empagliflozin for Heart Failure With Preserved Left Ventricular Ejection Fraction With and Without Diabetes — subgroup and prespecified analyses. (See EMPEROR subgroup analyses and extended data for effect modification by LVEF and other variables.) Note: No published score named "EMPEROR-Preserved Benefit Stratification Index" could be found in the trial publications or subsequent indexed analyses as of the consulted literature search; this calculator therefore implements a transparent, reproducible approximation built from the trial’s reported event rates and hazard ratio.