Diastolic Heart Failure Maintenance

@jc76
My dad has been taking Jaridance MWF for about six months now. I was hesitant to support this as it is quite expensive even in Southeast Asia where he lives most of the time, and I was wary as the "remodeling" pitch made me think more of new draperies than an improved heart. He started out taking it every day but his heart rate kept hitting "low" alarms while sleeping and sometimes when active. Now he takes it MWF, but the low heart rate alarms are still going off. Lowest so far has been 39, while asleep. He goes back to the cardiologist in a month.

He also takes Eliquis as a stroke preventative and lorezapam to help him sleep. He quit taking rosuvastatin as he felt terrible the entire time he was taking it, around five years.

He treadmills every other day for 50 minutes at max slope and around 4 mph, heart rate averaging around 115, about 80% of max for his age. He lifts light weights on the off days.

Recently it has been very hard to get his heart rate elevated while milling, so he starts out with jumping jacks until HR reaches 120, but "jumping" might not be the right word, his observation not mine.

He was diagnosed with heart failure about ten years ago, life expectancy pegged 2-5 years. But he was also told by a doctor friend that a treadmill could keep him alive longer. That's worked so far. Outside exercise is difficult here as it is too hot except for a few months per year. His goal to outlive his dogs. They are "inside" dogs, very rare here. Going back to the streets is not an option.

I would love to hear from anyone who has been taking Jardiance for a long time, but I think it's relatively new.

@william66
I am going to paste research information that I got and made clear the below came from A.I. Co-pilot Health. It provided research and studies on heart failure and Jardiance.

One thing I read relating to your post and your dad having low blood pressure. Is he on any other diuretic? In the A.I. information you will read side affects can be hypotension (low blood pressure) particularly if already on a diuretic.

This is long but did not want to cherry pick to not post all that was given. Again this is from A.I. but list the studies and resources it used to post the information.
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Jardiance for Heart Failure: What the Evidence Shows
What it is and how it's approved
Jardiance (empagliflozin) belongs to a drug class called SGLT2 inhibitors, which were originally developed to lower blood sugar in type 2 diabetes. Over time, researchers discovered they have powerful cardiovascular benefits independent of blood sugar control. The FDA has formally approved Jardiance to reduce the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure — regardless of whether the patient has diabetes.

The key trials
The heart failure evidence for Jardiance rests on two landmark trials published in the New England Journal of Medicine:

EMPEROR-Reduced (2020) enrolled 3,730 patients with heart failure and reduced ejection fraction (HFrEF — meaning the heart's pumping function is weakened). Patients received either Jardiance 10 mg daily or placebo on top of standard heart failure therapy. Over a median of 16 months, the risk of cardiovascular death or hospitalization for heart failure was 25% lower in the Jardiance group (hazard ratio 0.75). Total heart failure hospitalizations were reduced by 30%, and kidney function declined more slowly in the Jardiance group. Importantly, benefits were consistent regardless of whether patients had diabetes.

EMPEROR-Preserved (2021) addressed a different and harder-to-treat group: 5,988 patients with heart failure and preserved ejection fraction (HFpEF — where the heart pumps normally but has become stiff). This population had historically lacked effective drug therapies. Over a median of 26 months, Jardiance reduced the combined risk of cardiovascular death or heart failure hospitalization by 21% (hazard ratio 0.79), again regardless of diabetes status.

Together, these trials established Jardiance as one of the few treatments shown to benefit both major types of heart failure.
What the broader evidence shows
A 2024 meta-analysis pooling data from 15 studies and over 36,900 heart failure patients found that empagliflozin significantly reduced:

Heart failure hospitalization rates

Cardiovascular mortality

Decline in kidney function

It also improved quality of life scores, left ventricular ejection fraction (a measure of how well the heart pumps), and reduced cardiac stress markers (NT-proBNP).

A 2026 meta-analysis of 28 randomized controlled trials across SGLT2 inhibitors as a class — which includes Jardiance — found a 24% reduction in first hospitalization for heart failure and a 28% reduction in all-cause mortality. These benefits held for patients both with and without diabetes.
How it works in heart failure
Jardiance's heart failure benefits are thought to come from several overlapping mechanisms beyond blood sugar lowering:

Reducing fluid overload (it acts as a mild diuretic by promoting sodium and glucose excretion through the kidneys)

Lowering blood pressure and reducing the workload on the heart

Protecting kidney function, which matters greatly in heart failure management

Possible direct effects on heart muscle metabolism

Key side effects to be aware of
The most commonly reported side effects in the heart failure trials were:

Genital yeast infections (more common in women)

Urinary tract infections

Low blood pressure (hypotension), particularly relevant if already on diuretics

More serious but less common risks include volume depletion (dehydration) and, in people with type 1 diabetes specifically, diabetic ketoacidosis.

Bottom line
The evidence for Jardiance in heart failure is among the strongest in recent cardiovascular medicine. It is now a guideline-supported treatment for both HFrEF and HFpEF, and is one of the few drugs shown to reduce both hospitalizations and cardiovascular death in heart failure patients regardless of diabetes status.

That said, whether it's the right choice for any individual depends on kidney function, other medications, and overall clinical picture — so it's worth discussing the trial evidence directly with your cardiologist or prescribing physician. Would you like help preparing questions for that conversation?

@jc76
Thank you. That is exactly what we needed to see.

@william66
I probably should not have posted that long item from A.I. I know it is not what posters come for they want the personal experience of the other person.

I mentioned I would asked my heart failure doctor the resource information he used to put me on Jardiance. That is listed below and no where as long.

Jardiance (empagliflozin) may help your heart heal and function better over time. For some people with heart failure, it can help the heart become less enlarged and improve how efficiently it works. It has also been shown to reduce heart failure symptoms, lower the risk of hospitalization, and help slow the progression of heart failure.

While we can't guarantee it will improve heart function in every individual, it is one of the medications that may support healthy heart remodeling and better long-term outcomes for people with heart failure.

There is a nice user-friendly breakdown on the Behringer-Ingelheim (Jardiance's manufacturer) website of their Heart Failure Trial EMPEROR. Linked below.

HFrEF Efficacy & Data | Jardiance® (empagliflozin) tablets

The actual studies referenced in their presentation are listed at the bottom of that webpage - those would be the studies you're probably needing for your group.

Of note, their landmark trial was called the EMPEROR trial. An impactful piece to this study is that there were 2 arms to the study -one for reduced ejection fraction patients and one for preserved ejection fraction.

EMPEROR-Reduced Trial Investigators ejection fraction less than or equal to 40%
EMPEROR-Preserved Trial Investigators ejection fraction greater than 40%

There was a study where specific metrics associated with remodeling were reviewed as part of the Empire HF trial as well.

Associations of Empagliflozin With Left Ventricular Volumes, Mass, and Function in Patients With Heart Failure and Reduced Ejection Fraction: A Substudy of the Empire HF Randomized Clinical Trial | Heart Failure | JAMA Cardiology | JAMA Network

Hope this helps,

@jc76

It helps a lot. We live in rural SE Asia. Any information we get is useful.

@susala
I sent you a private message but not sure you got the information. Here is the research information my heart failure doctor used to put me on Jardiance with possibility of helping with my heart failure.
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"Jardiance (empagliflozin) may help your heart heal and function better over time. For some people with heart failure, it can help the heart become less enlarged and improve how efficiently it works. It has also been shown to reduce heart failure symptoms, lower the risk of hospitalization, and help slow the progression of heart failure."

"While we can't guarantee it will improve heart function in every individual, it is one of the medications that may support healthy heart remodeling and better long-term outcomes for people with heart failure."

"There is a nice user-friendly breakdown on the Behringer-Ingelheim (Jardiance's manufacturer) website of their Heart Failure Trial EMPEROR. Linked below."

"HFrEF Efficacy & Data | Jardiance® (empagliflozin) tablets"

"The actual studies referenced in their presentation are listed at the bottom of that webpage - those would be the studies you're probably needing for your group. "

"Of note, their landmark trial was called the EMPEROR trial. An impactful piece to this study is that there were 2 arms to the study -one for reduced ejection fraction patients and one for preserved ejection fraction."

"EMPEROR-Reduced Trial Investigators ejection fraction less than or equal to 40%
EMPEROR-Preserved Trial Investigators ejection fraction greater than 40%"

"There was a study where specific metrics associated with remodeling were reviewed as part of the Empire HF trial as well. "

"Associations of Empagliflozin With Left Ventricular Volumes, Mass, and Function in Patients With Heart Failure and Reduced Ejection Fraction: A Substudy of the Empire HF Randomized Clinical Trial | Heart Failure | JAMA Cardiology | JAMA Network"

"Hope this helps,:

Thanks it does look promising

@ohallk
My apology for late response. I’m not online much right now while recovering from ankle surgery. The “natural remedies” that work best for me is medical cannibus pain relief balm (100mg CBD)… I rub the balm all over my feet before bed and sometimes during the day. I use the balm occasionally on my shoulder for joint pain too, and it helps a lot. I have the med cannabis certification from my primary care doc, and buy the balm at a local dispensary in Illinois.
I also sometimes use “Seven Minerals Magnesium Oil Spray” on my feet and lower legs (avail on Amazon).
Soaking for a few minutes in a warm Epson Salt bath can be helpful for my feet too especially in cold weather.
Lastly, I regularly massage my feet and legs following a lymphatic drainage massage technique that I learned from a homeopathic therapist. There are free instructions available on YouTube as well. I firmly believe this helps because it keeps the swelling down in my feet which in turn helps with reducing the neuropathy pain.
I wish you the very best of luck with finding alternative ways to manage your peripheral neuropathy. If these methods don’t help you I encourage you to keep exploring other ways to reduce pain. Stopping the Gabapentin was the best thing I did for myself… my memory has greatly improved.