Dapagliflozin prevents worsening heart failure, CV death

Dapagliflozin is a safe treatment to reduce the risk of worsening heart failure (HF) or cardiovascular death both in patients with and without history of recent HF hospitalization, a study has shown.

A group of researchers randomly assigned 6,263 patients with HF and left ventricular ejection fraction (LVEF) >40 percent to treatment with either dapagliflozin or placebo in the DELIVER* trial. DELIVER allowed randomization during or shortly after hospitalization for HF in clinically stable patients off intravenous HF therapies.

This prespecified analysis determined whether recent HF hospitalization modified the risk of clinical events or response to dapagliflozin. Worsening HF event or cardiovascular death was the primary outcome.

Of the participants, 654 (10.4 percent) were randomized during HF hospitalization or within 30 days of discharge. Recent HF hospitalization contributed to a higher risk of the primary outcome following multivariable adjustment (hazard ratio [HR], 1.88, 95 percent confidence interval [CI], 1.60‒2.21; p<0.001).

Treatment with dapagliflozin reduced the primary outcome by 22 percent in recently hospitalized patients (HR, 0.78, 95 percent CI, 0.60‒1.03) and by 18 percent in those who had not been recently hospitalized (HR, 0.82, 95 percent CI, 0.72‒0.94; p_interaction=0.71).

In patients with recent hospitalization, the rates of adverse events, including volume depletion, diabetic ketoacidosis, or renal events, were similar between dapagliflozin and placebo.

“Starting dapagliflozin during or shortly after HF hospitalization in patients with mildly reduced or preserved LVEF appears safe and effective,” the researchers said.

*Dapagliflozin Evaluation to Improve the LIVES of Patients With PReserved Ejection Fraction Heart Failure