- Dapagliflozin (Farxiga) reduces hospitalization for heart failure (HHF) among patients with type 2 diabetes (T2D) and high cardiovascular risk, regardless of ejection fraction (EF) status.
Why this matters
- T2D is a well-established HF risk factor.
- Among 17,160 DECLARE-TIMI 58 trial participants, 3.9% had EFHF with reduced EF [HFrEF]), 7.7% had HF history without reduced EF, and 88.4% had no HF history or documented reduced EF.
- Funding: AstraZeneca.
- HR for dapagliflozin vs placebo for cardiovascular death/HFF overall:
- 0.83 (P=.005).
- Dapagliflozin reduced CV death/HHF risk (HRs, 95% CIs):
- In patients with HFrEF: 0.62 (0.45-0.86);
- Less so without HFrEF: 0.88 (0.76-1.02; Pinteraction=.046).
- Heterogeneity driven by dapagliflozin reducing cardiovascular death in patients (HRs; 95% CIs):
- With HFrEF: 0.55 (0.34-0.90; P=.02);
- But not without HFrEF: 1.08 (0.89-1.31; Pinteraction=.012).
- Dapagliflozin significantly reduced all-cause mortality (HRs; 95% CIs):
- With HFrEF: 0.59 (0.40-0.88; P=.01);
- But not without: 0.97 (Pinteraction=.016).
- Dapagliflozin reduced HHF regardless of EF (HR; 95% CIs):
- With HFrEF: 0.64 (0.43-0.95);
- Without HFrEF: 0.76 (0.62-0.92; Pinteraction=.45).
- No heterogeneity between patients with HF without known HFrEF vs with no HF history (HRs; 95% CIs):
- 0.72 (0.50-1.04) vs
- 0.77 (0.60-0.97), respectively.
- Trial not designed specifically to assess HF patients.
- No specified preenrollment time window for EF determination.