Takeaway
- This post hoc analysis of DAPA-HF trial found that anaemia was common in patients with heart failure and reduced ejection fraction (HFrEF) and was associated with worse outcomes, especially if persistent.
- Dapagliflozin corrected anaemia more often than placebo and improved outcomes, regardless of anaemia status at baseline.
Why this matters
- Findings suggest that in many patients with HFrEF, anaemia is transient and reversible, but that when it persists, it is associated with poorer outcomes.
Study design
- DAPA-HF was a phase 3, placebo-controlled trial involving 4744 patients with HFrEF and left ventricular ejection fraction of ≤40%.
- This post hoc analysis evaluated the effect of dapagliflozin on correction of anaemia in patients with HFrEF.
- The primary outcome was a composite of worsening heart failure (HF) (hospitalisation or urgent visit requiring intravenous therapy) or cardiovascular (CV) death.
- Funding: AstraZeneca.
Key results
- 4691 patients had a haematocrit available at baseline, of which 1032 (22.0%) were anaemic.
- The rate of the primary outcome was higher in patients with anaemia vs those without (16.1 vs 12.9 per 100 person-years; adjusted HR, 1.06; 95% CI, 0.91-1.25; P=.45).
- Anaemia was corrected in 62.2% of patients in the dapagliflozin group vs 41.1% of patients in the placebo group (OR, 2.37; 95% CI, 1.84-3.04; P<.001).
- The beneficial effect of dapagliflozin vs placebo on the primary outcome was consistent in patients with anaemia vs those without (HR, 0.68; 95% CI, 0.52-0.88 vs HR, 0.76; 95% CI, 0.65-0.89; Pinteraction=.44).
- Similar findings were observed for:
- CV death (Pinteraction=.48);
- HF hospitalisation (Pinteraction=.48);
- all-cause mortality (Pinteraction=.67); and
- total HF hospitalisations and CV death (Pinteraction=.30).
- Patients with resolution of anaemia had better outcomes vs those in which anaemia persisted (rate of primary outcome: 19.7 vs 27.7 per 100 person-years).
Limitations
- Post hoc analysis.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.