Dapagliflozin beneficial in heart failure

Treatment with dapagliflozin leads to lower incidence of total heart failure (HF) events and cardiovascular death, regardless of patient characteristics such as ejection fraction (EF), according to a study.

The study used data from the DELIVER trial to evaluate the effect of dapagliflozin on total HF events and cardiovascular death. A total of 6,263 HF patients (mean age 71.7 years, 43.9 percent women) who received either dapagliflozin 10 mg or matching placebo once daily were included in the analysis. The outcome was total episodes of worsening HF (hospitalization for HF or urgent HF visit requiring intravenous HF therapies) and cardiovascular death.

There were 1,057 HF events and cardiovascular deaths recorded in the placebo group and 815 in the dapagliflozin group. Those who had more HF events had features of more severe HF, including higher N-terminal pro–B-type natriuretic peptide level, worse kidney function, more frequent prior HF hospitalizations, and longer HF duration. However, EF was similar in patients with and without HF events.

In the Lin, Wei, Yang, and Ying (LWYY) model, the rate ratio for total HF events and cardiovascular death with dapagliflozin vs placebo was 0.77 (95 percent confidence interval [CI], 0.67–0.89; p<0.001), whereas the hazard ratio was 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 mortality.

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