Dapagliflozin use tied to reduced mortality and hospitalisation in patients with heart failure

  • McMurray JJV & al.
  • N Engl J Med
  • 19 Sep 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with heart failure (HF) and reduced ejection fraction, dapagliflozin treatment was associated with a lower risk for worsening HF or death from cardiovascular causes compared with placebo, regardless of the presence or absence of diabetes.

Why this matters

  • Dapagliflozin, a sodium-glucose co-transporter 2 inhibitor, is already used for the treatment of type 2 diabetes and prevents HF development in these patients, but DAPA-HF trial demonstrated that dapagliflozin can be used to treat pre-existing HF, even in patients without diabetes.

Study design

  • In DAPA-HF trial, 4744 patients with HF and an ejection fraction of ≤40% with or without diabetes were randomly assigned to receive dapagliflozin (10-mg once daily; n=2373) or placebo (n=2371), in addition to recommended therapy.
  • Primary outcome: composite of worsening of HF or cardiovascular death.
  • Funding: AstraZeneca.

Key results

  • Over a median of 18.2-month follow-up, primary composite outcome occurred in 386 (16.3%) and 502 (21.2%) patients in the dapagliflozin and placebo group (HR, 0.74; 95% CI, 0.65-0.85; P<.001 respectively.>
  • 231 (9.7%) vs 318 (13.4%) patients were hospitalised for HF in the dapagliflozin and placebo group (HR, 0.70; 95% CI, 0.59-0.83), respectively.
  • The incidence of following outcomes was lower in dapagliflozin vs placebo group:
    • death from cardiovascular causes (227 [9.6%] vs 273 [11.5%] patients; HR, 0.82; 95% CI, 0.69-0.98) and
    • death from any cause (276 [11.6%] vs 329 [13.9%]; HR, 0.83; 95% CI, 0.71-0.97).
  • Similar results were observed in patients with or without diabetes.
  • Frequency of adverse events related to volume depletion (1.2% vs 1.7%; P=.23), renal dysfunction (1.6% vs 2.7%; P=.009) and hypoglycaemia did not differ between the groups.

Limitations

  • Limited generalisability.