Dapagliflozin helps prevent heart failure events, cardiovascular death

Treatment with dapagliflozin leads to a reduction in the rate of total heart failure (HF) events and cardiovascular death, irrespective of patient characteristics such as ejection fraction (EF), according to data from the DELIVER* trial.

DELIVER included 6,263 HF patients (mean age 71.7 years, 43.9 percent women) with mildly reduced EF (HFmrEF) or preserved (HFpEF). These patients were randomly assigned to receive treatment with the SGLT2 inhibitor dapagliflozin 10 mg or matching placebo, administered once daily.

For the prespecified analysis, researchers used the proportional rates approach of Lin, Wei, Yang, and Ying (LWYY) and a joint frailty model to examine the effect of dapagliflozin on total HF events and cardiovascular death. The effect of dapagliflozin was tested for heterogeneity in several patient subgroups, including those with left ventricular EF.

A total of 1,057 HF events and cardiovascular deaths occurred in the placebo group and 815 in the dapagliflozin group. Patients who experienced more HF events had features of more severe HF, such as higher N-terminal pro–B-type natriuretic peptide level, worse kidney function, more prior HF hospitalizations, and longer duration of HF. However, EF was not significantly different between patients who did and did not have HF events.

In the LWYY model, dapagliflozin was associated with a decreased rate of total HF events and cardiovascular death for dapagliflozin, with a rate ratio of 0.77 (95 percent confidence interval [CI], 0.67–0.89; p<0.001) as opposed to a hazard ratio of 0.82 (95 percent CI, 0.73–0.92; p<0.001) in a traditional time to first event analysis.

In the joint frailty model, the rate ratio was 0.72 (95 percent CI, 0.65–0.81; p<0.001) for total HF events and 0.87 (95 percent CI, 0.72–1.05; p=0.14) for cardiovascular death.

The results for total HF hospitalizations (without urgent HF visits) and cardiovascular death were consistent across all subgroups, including those defined by EF.

*Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure trial