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Fewer deaths and hospitalisations in HF patients with SGLT2-inhibitor dapagliflozin

Professor John McMurray, Glasgow, Scotland, United Kingdom
ESC 2019
Treatment with SGLT2-inhibitor dapagliflozin reduces the rates of death and hospitalisation in patients with heart failure and reduced left ventricular ejection fraction (HFrEF) with and without diabetes. Professor John McMurray (Glasgow, Scotland, United Kingdom) stated that the most important finding was the benefit in patients without diabetes.

The DAPA-HF trial investigated whether dapagliflozin would also be useful in treating established HF, even in patients without diabetes. A total of 4,744 HFrEF patients from 20 countries was enrolled and randomised to either dapagliflozin 10 mg once daily or matching placebo. Primary endpoint of the study was the composite of a first episode of worsening HF (defined as hospitalisation for HF, or HF requiring intravenous therapy) or death from cardiovascular (CV) causes. Apart from the treatment with dapagliflozin or placebo, patients received an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker or an angiotensin receptor-neprilysin inhibitor in 94% of cases, whereas 96% received a beta-blocker and 71% received a mineralocorticoid receptor antagonist. Median follow-up was 18.2 months. It was found that 16.3% of patients in the dapagliflozin group and 21.2% of patients in the placebo group (HR 0.74; 95% CI 0.65 to 0.85; P<0.00001) met the primary endpoint. When assessed in detail, it was shown that 10.0% of patients receiving dapagliflozin and 13.7% receiving placebo had a first episode of worsening HF (HR 0.70, 95% CI 0.59 to 0.83; P<0.0000]); 9.6% of dapagliflozin patients versus 11.5% of placebo patients died from CV causes (HR 0.82, 95% CI 0.69 to 0.98; P=0.029). Side effects occurred in 7.5% of dapagliflozin patients vs 6.8% of placebo patients. Thus, dapagliflozin reduces death and hospitalisation, and improves health-related quality of life (HrQoL) in HFrEF patients with and without diabetes [1].

1. McMurray JJV. DAPA HF - The Dapagliflozin And Prevention Of Adverse-outcomes In Heart Failure Trial. Late-Breaking Science. ESC Congress 2019, 31 Aug-4 Sept, Paris, France.

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