Dapagliflozin reduces the risks of death and cardiovascular events in patients with heart failure, regardless of ejection fraction, according to late-breaking research presented today at a Hot Line session at ESC Congress 2022.
This pre-specified patient-level meta-analysis combined the DAPA-HF and DELIVER trials of the SGLT2 inhibitor dapagliflozin in patients with heart failure. DAPA-HF enrolled patients with reduced ejection fraction (40% or less) and DELIVER enrolled patients with mildly reduced and preserved ejection fraction (above 40%). Both trials randomized participants to dapagliflozin 10 mg once daily or placebo.
The first aim of this analysis was to examine the effect of dapagliflozin on a number of secondary outcomes that each trial alone was insufficiently powered to examine. The second objective was to examine whether dapagliflozin was effective across the ejection fraction range, as the EMPEROR-Preserved trial previously suggested that the effect of empagliflozin, another SGLT2 inhibitor, may be attenuated in patients with an ejection fraction highest.
A total of 11,007 patients were randomized to dapagliflozin or placebo in the two trials. Survival analysis was used to examine the effect of dapagliflozin on death from cardiovascular causes; death from any cause; total hospital admissions for heart failure; and the composite of death from cardiovascular causes, myocardial infarction, or stroke (major adverse cardiovascular events; MACE).
The average age of the participants was 69 years and 35% were women. The median follow-up was 1.8 years. Dapagliflozin reduced the risk of death from cardiovascular causes by 14% (hazard ratio [HR] 0.86; 95% confidence interval [CI] 0.76-0.97; p=0.01), death from any cause in 10% (HR 0.90; 95% CI 0.82-0.99; p=0.03), total hospital admissions for heart failure in 29% (Relative risk [RR] 0.71; CI 95% 0.65-0.78; p<0.001) and MACE in 11% (HR 0.90; 95% CI 0.81-1.00; p=0.045). There was no evidence that the effect of dapagliflozin differed by ejection fraction for any of the outcomes.
Our findings confirm that all heart failure patients, regardless of ejection fraction, can benefit from dapagliflozin in addition to any other heart failure therapy they are receiving.”
Pardeep Jhund, study author, professor at the University of Glasgow, UK
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