TY - JOUR
T1 - Dapagliflozin in heart failure with improved ejection fraction
T2 - a prespecified analysis of the DELIVER trial
AU - Vardeny, Orly
AU - Fang, James C.
AU - Desai, Akshay S.
AU - Jhund, Pardeep S.
AU - Claggett, Brian
AU - Vaduganathan, Muthiah
AU - de Boer, Rudolf A.
AU - Hernandez, Adrian F.
AU - Lam, Carolyn S.P.
AU - Inzucchi, Silvio E.
AU - Martinez, Felipe A.
AU - Kosiborod, Mikhail N.
AU - DeMets, David
AU - O’Meara, Eileen
AU - Zieroth, Shelley
AU - Comin-Colet, Josep
AU - Drozdz, Jaroslaw
AU - Chiang, Chern En
AU - Kitakaze, Masafumi
AU - Petersson, Magnus
AU - Lindholm, Daniel
AU - Langkilde, Anna Maria
AU - McMurray, John J.V.
AU - Solomon, Scott D.
N1 - Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - With modern treatments for heart failure with reduced ejection fraction (EF), indicative of impaired cardiac systolic function, patients may exhibit an increase in EF. Limited data are available regarding the clinical management of this growing population, categorized as heart failure with improved EF (HFimpEF), which has a high event rate and has been excluded from virtually all prior heart failure outcomes trials. In a prespecified analysis of the DELIVER trial (NCT03619213), of a total of 6,263 participants with symptomatic heart failure and a left ventricular EF >40%, 1,151 (18%) had HFimpEF, defined as patients whose EF improved from ≤40% to >40%. Participants were randomized to 10 mg dapagliflozin or placebo daily and the primary outcome of the trial was a composite of cardiovascular death or worsening heart failure (heart failure hospitalization or an urgent heart failure visit). Participants with HFimpEF had similar event rates to those with an EF consistently >40%. In participants with HFimpEF, dapagliflozin reduced the primary composite outcome (hazard ratio (HR) = 0.74, 95% confidence interval (CI) = 0.56–0.97), first worsening heart failure events (HR = 0.78, 95% CI = 0.61–1.14), cardiovascular death (HR = 0.62, 95% CI = 0.41–0.96) and total worsening heart failure events (rate ratio = 0.68, 95% CI = 0.50–0.94) to a similar extent as for individuals with an EF consistently >40%. These data suggest that patients with HFimpEF who are symptomatic may benefit from the addition of a sodium/glucose cotransporter 2 inhibitor to previously instituted guideline-directed medical therapy to further reduce morbidity and mortality.
AB - With modern treatments for heart failure with reduced ejection fraction (EF), indicative of impaired cardiac systolic function, patients may exhibit an increase in EF. Limited data are available regarding the clinical management of this growing population, categorized as heart failure with improved EF (HFimpEF), which has a high event rate and has been excluded from virtually all prior heart failure outcomes trials. In a prespecified analysis of the DELIVER trial (NCT03619213), of a total of 6,263 participants with symptomatic heart failure and a left ventricular EF >40%, 1,151 (18%) had HFimpEF, defined as patients whose EF improved from ≤40% to >40%. Participants were randomized to 10 mg dapagliflozin or placebo daily and the primary outcome of the trial was a composite of cardiovascular death or worsening heart failure (heart failure hospitalization or an urgent heart failure visit). Participants with HFimpEF had similar event rates to those with an EF consistently >40%. In participants with HFimpEF, dapagliflozin reduced the primary composite outcome (hazard ratio (HR) = 0.74, 95% confidence interval (CI) = 0.56–0.97), first worsening heart failure events (HR = 0.78, 95% CI = 0.61–1.14), cardiovascular death (HR = 0.62, 95% CI = 0.41–0.96) and total worsening heart failure events (rate ratio = 0.68, 95% CI = 0.50–0.94) to a similar extent as for individuals with an EF consistently >40%. These data suggest that patients with HFimpEF who are symptomatic may benefit from the addition of a sodium/glucose cotransporter 2 inhibitor to previously instituted guideline-directed medical therapy to further reduce morbidity and mortality.
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U2 - 10.1038/s41591-022-02102-9
DO - 10.1038/s41591-022-02102-9
M3 - Article
C2 - 36522606
AN - SCOPUS:85143982314
SN - 1078-8956
VL - 28
SP - 2504
EP - 2511
JO - Nature Medicine
JF - Nature Medicine
IS - 12
ER -