Physicians' Academy for Cardiovascular Education

Beneficial effect of SGLT2i in HFrEF independent of use of diuretic therapy

News - June 23, 2020

Dapagliflozin and diuretic use in patients with heart failure and reduced ejection fraction in DAPA-HF

HFA Discoveries 2020 webinar presented by dr. Alice Jackson (Glasgow,GB)

Introduction and methods

The DAPA-HF trial showed that SGLT2 inhibitor dapagliflozin reduced the risk of worsening heart failure (HF) or CV death in patients with HFrEF. Effects of SGLT2 inhibition include natriuresis, glycosuria and water excretion. In DAPA-HF, 84% of patients were treated with conventional diuretics at baseline. However, little is known about the effects of adding a SGLT2 inhibitor in patients with HFrEF who are already on conventional diuretic therapy.

This analysis of patients in the DAPA-HF trial investigated efficacy and safety outcomes according to diuretic category. A total of 4616 patients from the DAPA-HF trial were categorized into 4 groups according to furosemide-equivalent daily doses of loop diuretic: no diuretic (n=736),<40 mg (n=1311), 40 mg (n=1365) and >40 mg (n=1204). Patients on a non-loop diuretic only were included in the <40 mg group.

Main results


This analysis showed that most patients did not change diuretic dose during follow-up in the DAPA-HF trial. Benefits of dapagliflozin in reducing the risk of the primary composite endpoint, its components and all-cause death persisted irrespective of use of diuretics or diuretic dose. Renal adverse events and discontinuation due to adverse events were not more frequent in patients receiving dapagliflozin, compared to patients on placebo. Treatment with dapagliflozin led to a sustained elevation of hematocrit, irrespective of use of diuretic, dose or change of dose.

-Our reporting is based on the information provided by the HFA Discoveries webinar -

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