https://doi.org/10.55788/25666918
The pre-specified meta-analysis from 2 randomised phase 3 trials interrogating the efficacy of the SGLT2 inhibitor dapagliflozin (10 mg once daily) versus placebo in HF, DAPA-HF (EF <40%, NCT03036124) and DELIVER (EF >40%, NCT03619213), was presented by Prof. Pardeep Jhund (University of Glasgow, UK) and simultaneously published in the journal Nature Medicine [1–4].
Collectively, the average age of participants (n=11,007) was 69 years, 35% were women, and there was a median follow-up of 1.8 years. The survival data were strong; dapagliflozin reduced the risk of death from cardiovascular causes by 14% (HR 0.86; 95% CI 0.76–0.97; P=0.01), death from any cause by 10% (HR 0.90; 95% CI 0.82–0.99; P=0.03), total hospital admissions for HF by 29% (RR 0.71; 95% CI 0.65–0.78; P<0.001), and major adverse cardiovascular events by 10%, the latter with only borderline statistical significance (HR 0.90; 95% CI 0.81–1.00; P=0.045). In subgroup analyses, it was evident that the baseline ejection fraction (EF) of the participants did not significantly alter any of the individual or composite outcomes.
Using the data from this pooled analysis, the number of patients with HF who needed to be treated (NNT) for a median of 22 months to prevent 1 death from cardiovascular causes was 68 (95% CI 39–281). This analysis supports a recommendation that treatment with dapagliflozin can be initiated in patients with a clinical diagnosis of HF and no contraindications, even if a measurement of EF is awaited.
Prof. Jhund concluded: “Our findings confirm that all patients with HF, regardless of EF, may benefit from dapagliflozin in addition to any other HF therapy they are receiving.”
- McMurray JJV, et al. N Engl J Med. 2019 Nov 21;381(21):1995–2008.
- Solomon S, et al. DELIVER - Dapagliflozin in Heart Failure with Mildly Reduced and Preserved Ejection Fraction. Hot Line Session 4, ESC Congress 2022, Barcelona, Spain, 26–29 August.
- Jhund P, et al. Pooled analysis of DAPA-HF and DELIVER. Hot Line Session 4, ESC Congress 2022, Barcelona, Spain, 26–29 August.
- Jhund PS, et al. Nat Med. 2022. doi: 10.1038/s41591-022-01971-4.
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Table of Contents: ESC 2022
Featured articles
ESC Clinical Practice Guidelines
Prevention of VT and sudden cardiac death: the new recommendations
New and first ESC cardio-oncology guideline
The 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension
Cardiovascular assessment and management of patients undergoing non-cardiac surgery
Heart Failure
Old dogs, new tricks: Acetazolamide plus loop diuretics improves decongestion
No effect of neprilysin inhibition on cognition
Dapagliflozin DELIVERs for HFmrEF/HFpEF
Meta-analysis of DELIVER and EMPEROR-Preserved
Anticoagulation
Rheumatic heart disease-associated AF: standard-of-care holds ground
New anticoagulant safe and maybe effective: PACIFIC-AMI and PACIFIC-Stroke outcomes
AXIOMATIC-SSP: Reducing risk of ischaemic stroke with factor XIa inhibition?
Evolving evidence for P2Y12 inhibition in chronic coronary syndromes: PANTHER
Prevention
Danish study suggests starting CVD screening before age 70
Polypill SECUREs win in secondary prevention in elderly
Long-term therapy with evolocumab associated with lower CV mortality
ARBs + beta-blockers may delay Marfan syndrome aortic root replacement
ENTRIGUE: Subcutaneous pegozafermin in severe hypertriglyceridaemia
Artificial Intelligence & Digital Health – What Is New
First RCT evidence for use of AI in daily practice
AI-enhanced echography supports aortic stenosis patients
Ischaemia
Medical therapy versus PCI for ischaemic cardiomyopathy
Allopurinol disappoints in ALL-HEART
Conservative or invasive management for high-risk kidney disease patients with ischaemia?
Genotype-guided antiplatelet therapy in patients receiving PCI
Other HOTLINE Sessions
BOXing out oxygen and blood pressure targets
Coronary CT angiography diagnostics compared head-to-head
High-dose influenza vaccine: mortality benefit?
FFR-guided decision-making in patients with AMI and multivessel disease
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