Dapagliflozin reduces HF hospitalization in high-risk T2D patients regardless of EF

  • Kato ET & al.
  • Circulation
  • 18 Mar 2019

  • International Clinical Digest
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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. 

Limitations

  • Trial not designed specifically to assess HF patients.
  • No specified preenrollment time window for EF determination.