Improved outcomes with SGLT2i across entire ejection fraction range

ESC 2022 A pooled analysis of DAPA-HF and DELIVER was undertaken to examine the effect of dapagliflozin in patient with heart failure across the entire spectrum of ejection fraction.

Presented at the ESC congress 2022 by: Pardeep Jhund, MD, PhD – Glasgow, UK

Introduction and methods

Up to 55% of patients with HF may have HFpEF in daily clinical practice. These patients have poor outcomes and treatment options are very limited. Last year, trial results showed improved outcomes with a member of the SGLT2i class in patients with HFpEF. It was suggested though that patients with a high ejection fraction may not benefit from this drug.

An analysis was performed of two trials testing the effect of dapagliflozin in patients with heart failure; the DAPA-HF (n=4744) and DELIVER (n=6263) – pooled dataset was n=11.007. Patients were randomized to dapagliflozin 10 mg once daily or placebo. The combined trials cover the entire spectrum of ejection fraction. Median LVEF was 44%. And median follow-up was 22 (IQR 17-30) months.

Main results

• In the dapagliflozin group, rate of CV death events was lower compared to the placebo group (HR 0.86, 95%CI:0.76-0.97, P=0.01). There was no interaction for LVEF of the effect of dapagliflozin on CV death (Pinteraction=0.94).
• Event rate of all other outcomes were lower in the dapagliflozin group compared to the placebo group. HRs for outcomes were as follows: all-cause death 0.90 (95%CI:0.82-0.99); total HF hospitalization 0.71 (95%CI:0.65-0.78); CV death, MI or stroke (MACE) 0.90 (95%CI:0.81-1.00); first HF hospitalization 0.74 (95%CI:0.66-0.82); CV death of first HF hospitalization 0.78 (95%CI:0.72-0.86).

Conclusion

The SGLT2 inhibitor dapagliflozin reduced the risk of CV death, all-cause death, total HF hospitalizations and MACE in the entire spectrum of LVEF in patients with HF.

Jhund said this finding is clinically important as patients often have to wait for a heart scan to measure ejection fraction and decide the indicated therapies. Now, dapagliflozin can be prescribed before ejection fraction is measured, thereby speeding up the access to this drug (provided patients have no contraindications).

- Our reporting is based on the information provided at the ESC Congress -

The findings of this pooled analysis were simultaneously published in Nature Medicine Watch a video by prof. Jhund on this analysis