Jardiance is FDA-approved to treat heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), making it the first SGLT2 inhibitor approved across the full heart failure spectrum. In the EMPEROR-Reduced and EMPEROR-Preserved trials, Jardiance reduced cardiovascular death or heart failure hospitalization by roughly 25 and 21 percent respectively. The benefit applies regardless of whether the patient has diabetes. The dose is 10 mg once daily.
What Heart Failure Means
Heart failure is a clinical syndrome where the heart cannot pump enough blood to meet the body’s needs at normal filling pressures. It is classified by left ventricular ejection fraction (LVEF):
- HFrEF — heart failure with reduced ejection fraction (LVEF less than 40 percent)
- HFmrEF — heart failure with mildly reduced EF (LVEF 41 to 49 percent)
- HFpEF — heart failure with preserved EF (LVEF 50 percent or above)
- Symptoms — shortness of breath, fatigue, leg swelling, exercise intolerance, weight gain from fluid retention
- Common causes — coronary artery disease, hypertension, cardiomyopathy, valvular disease, diabetes
The EMPEROR Trials
| Trial | Population | Primary Endpoint | Result |
|---|---|---|---|
| EMPEROR-Reduced (2020) | 3,730 HFrEF with or without T2D | CV death or HF hospitalization | 25 percent reduction (HR 0.75) |
| EMPEROR-Preserved (2021) | 5,988 HFpEF with or without T2D | CV death or HF hospitalization | 21 percent reduction (HR 0.79) |
| EMPULSE (2022) | Acute HF hospitalization | Composite clinical benefit | Improved at 90 days |
How Jardiance Works in Heart Failure
The exact mechanism is multifactorial — Jardiance influences heart failure through several pathways at once, which is part of why benefit appears across both reduced and preserved ejection fraction.
- Reduces preload — natriuresis and osmotic diuresis lower intravascular volume
- Improves myocardial energetics — promotes ketone use as an efficient cardiac fuel
- Reduces myocardial fibrosis and adverse remodeling
- Lowers blood pressure modestly without reflex tachycardia
- Reduces inflammation and oxidative stress in cardiac tissue
- Improves erythropoiesis and corrects mild anemia, increasing oxygen delivery
- Reduces left ventricular wall stress
Who Is Eligible
- Adults with chronic HFrEF or HFpEF
- Symptoms of heart failure (NYHA class II to IV)
- eGFR ≥ 20 mL/min/1.73 m²
- Hemodynamically stable — not in cardiogenic shock
- Not type 1 diabetes
- No history of severe SGLT2 inhibitor hypersensitivity
How It Is Used
- Dose — 10 mg once daily
- Timing — typically in the morning, with or without food
- No titration needed
- Continued indefinitely unless serious adverse event
- Added on top of standard guideline-directed medical therapy (GDMT) — beta blocker, ACE inhibitor / ARB / ARNI, MRA, loop diuretic as needed
- Loop diuretic may need to be reduced by 25 to 50 percent in the first weeks to avoid over-diuresis
Common Side Effects in HF Patients
| Side Effect | Frequency | Management |
|---|---|---|
| Genital yeast infection | 8 to 12 percent | Topical antifungal; usually does not require stopping the drug |
| Urinary tract infection | 5 to 9 percent | Standard treatment; assess recurrence |
| Volume depletion | 3 to 5 percent (higher in elderly) | Reduce diuretic; monitor BP and weight |
| Dizziness on standing | 2 to 4 percent | Slow position changes; check orthostatics |
| Hypoglycemia (if on insulin / SU) | Variable | Reduce insulin or sulfonylurea |
| Euglycemic DKA | Less than 0.1 percent | Hold for illness, surgery; check ketones if symptoms |
When to Hold Jardiance
- Major illness with fever, vomiting, or inability to eat (DKA risk)
- Scheduled surgery — hold 3 days before
- Acute kidney injury
- Volume depletion or aggressive over-diuresis
- Active serious infection until resolved
- Severe foot ulcer at risk of progression
What Improvement Looks Like
- Less shortness of breath with daily activity within weeks
- Better exercise tolerance
- Lower body weight from mild fluid loss in the first 1 to 2 weeks
- Fewer hospital visits over months and years
- Modest blood pressure reduction
- Improved KCCQ (Kansas City Cardiomyopathy Questionnaire) scores in clinical trials
- Slowed kidney function decline
Cost and Access
- US retail — about $570 per month for 30 tablets
- Insurance commonly covers it with prior authorization for heart failure indication
- Manufacturer copay card — as low as $10 per month for commercially insured patients
- Medicare Part D — variable; the Inflation Reduction Act began Medicare price negotiation for empagliflozin in 2026
- No US generic available as of 2026
Where Jardiance Fits in Guidelines
The 2022 AHA / ACC / HFSA heart failure guidelines and the 2023 ESC focused update both list SGLT2 inhibitors as part of the four foundational therapies (along with beta blocker, ARNI / ACEi / ARB, and MRA) for HFrEF. For HFpEF, SGLT2 inhibitors are the first class with a class I recommendation backed by trial data. Jardiance is one of two SGLT2 inhibitors with full HF spectrum approval in the US (the other is Farxiga).
Related Reading
See our treatment hub, Jardiance and CKD, and Is Jardiance for diabetes. For trial evidence, see the EMPEROR-Reduced trial and the EMPEROR-Preserved trial.
The Bottom Line
Jardiance is FDA-approved for both reduced and preserved ejection fraction heart failure, with or without diabetes. In the EMPEROR-Reduced and EMPEROR-Preserved trials it reduced cardiovascular death and heart failure hospitalization by about 21 to 25 percent. The dose is 10 mg once daily, added to standard heart failure therapy. Benefits begin within weeks. Side effects include genital yeast infections and mild volume depletion. Rare euglycemic DKA requires holding the drug for illness or surgery. Talk to your doctor about whether Jardiance fits your heart failure regimen, especially if you also have kidney disease or diabetes.
