Patients with heart failure benefit from dapagliflozin regardless of ejection fraction

Medical Xpress / European Society of Cardiology / ESC Congress 2022 ^ | August 29, 2022 | Professor Pardeep Jhund et al

[ConservativeMind]

Dapagliflozin reduces the risks of death and cardiovascular events in patients with heart failure regardless of ejection fraction, according to research.

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 randomly allocated 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 not powered to examine. The second aim was to examine if dapagliflozin was effective across the entire range of ejection fraction, since the EMPEROR-Preserved trial previously suggested that the effect of empagliflozin, another SGLT2 inhibitor, may be attenuated in patients with higher ejection fraction.

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.

The average age of 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 by 10% (HR 0.90; 95% CI 0.82–0.99; p=0.03), total hospital admissions for heart failure by 29% (relative risk [RR] 0.71; 95% CI 0.65–0.78; p<0.001) and MACE by 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.

Study author Professor Pardeep Jhund said, "Our findings confirm that all patients with heart failure, regardless of ejection fraction, may benefit from dapagliflozin in addition to any other heart failure therapy they are receiving."

[ConservativeMind]

A bit of promise from a drug that appears to run around $500 a prescription.

[ConservativeMind]

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[jimtorr]

$500? That is quite expensive.

I am living with heart failure, but with the help of a pacemaker I’m fine. Also very minor ejection, under 2%.

Glad I don’t need the drugs.

[RummyChick]

Do you happen to know what it means when you get inadequate TR jet. I have Stage 1 diastolic dysfunction which is common in older people.

[jimtorr]

The best article I’ve been able to find is this: https://johnsonfrancis.org/general/what-is-mild-tricuspid-regurgitation/

The article talks about TR (Tricuspid Regurgitation), and contains a YouTube video as well. Hope it helps.

[RummyChick]

Thanks. I am going to ask my GP when I see him if I need some other kind of test.