Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction

Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of hospitalization for heart failure and cardiovascular death among patients with chronic heart failure and a left ventricular ejection fraction of 40% or less. Whether SGLT2 inhibitors are effective in patients with a higher left ven...

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Veröffentlicht in:	The New England journal of medicine Jg. 387; H. 12; S. 1089 - 1098
Hauptverfasser:	Solomon, Scott D., McMurray, John J.V., Claggett, Brian, de Boer, Rudolf A., DeMets, David, Hernandez, Adrian F., Inzucchi, Silvio E., Kosiborod, Mikhail N., Lam, Carolyn S.P., Martinez, Felipe, Shah, Sanjiv J., Desai, Akshay S., Jhund, Pardeep S., Belohlavek, Jan, Chiang, Chern-En, Borleffs, C. Jan Willem, Comin-Colet, Josep, Dobreanu, Dan, Drozdz, Jaroslaw, Fang, James C., Alcocer-Gamba, Marco Antonio, Al Habeeb, Waleed, Han, Yaling, Cabrera Honorio, Jose Walter, Janssens, Stefan P., Katova, Tzvetana, Kitakaze, Masafumi, Merkely, Béla, O’Meara, Eileen, Saraiva, Jose Francisco Kerr, Tereshchenko, Sergey N., Thierer, Jorge, Vaduganathan, Muthiah, Vardeny, Orly, Verma, Subodh, Pham, Vinh Nguyen, Wilderäng, Ulrica, Zaozerska, Natalia, Bachus, Erasmus, Lindholm, Daniel, Petersson, Magnus, Langkilde, Anna Maria
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States Massachusetts Medical Society 22.09.2022
Schlagworte:	Antidiabetics Benzhydryl Compounds - adverse effects Benzhydryl Compounds - therapeutic use Benzhydryl Compounds/adverse effects/therapeutic use Cardiology Cardiology General Congestive heart failure Coronaviruses COVID-19 Death Diabetes Diabetes Mellitus Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - drug therapy Disease prevention Ejection fraction Glucosides - adverse effects Glucosides - therapeutic use Glucosides/adverse effects/therapeutic use Heart Failure Heart Failure - complications Heart Failure - drug therapy Heart Failure - mortality Heart Failure - physiopathology Heart Failure/complications/drug therapy/mortality/physiopathology Hospitalization Humans Inhibitor drugs Left/drug effects Placebos Sodium-glucose cotransporter Sodium-Glucose Transporter 2 Inhibitors - adverse effects Sodium-Glucose Transporter 2 Inhibitors - pharmacology Sodium-Glucose Transporter 2 Inhibitors - therapeutic use Sodium-Glucose Transporter 2 Inhibitors/adverse effects/pharmacology/therapeutic use Stroke Volume - drug effects Type 2/complications/drug therapy Ventricle Ventricular Function Ventricular Function, Left - drug effects
ISSN:	0028-4793, 1533-4406, 1533-4406
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Zusammenfassung:	Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of hospitalization for heart failure and cardiovascular death among patients with chronic heart failure and a left ventricular ejection fraction of 40% or less. Whether SGLT2 inhibitors are effective in patients with a higher left ventricular ejection fraction remains less certain. We randomly assigned 6263 patients with heart failure and a left ventricular ejection fraction of more than 40% to receive dapagliflozin (at a dose of 10 mg once daily) or matching placebo, in addition to usual therapy. The primary outcome was a composite of worsening heart failure (which was defined as either an unplanned hospitalization for heart failure or an urgent visit for heart failure) or cardiovascular death, as assessed in a time-to-event analysis. Over a median of 2.3 years, the primary outcome occurred in 512 of 3131 patients (16.4%) in the dapagliflozin group and in 610 of 3132 patients (19.5%) in the placebo group (hazard ratio, 0.82; 95% confidence interval [CI], 0.73 to 0.92; P<0.001). Worsening heart failure occurred in 368 patients (11.8%) in the dapagliflozin group and in 455 patients (14.5%) in the placebo group (hazard ratio, 0.79; 95% CI, 0.69 to 0.91); cardiovascular death occurred in 231 patients (7.4%) and 261 patients (8.3%), respectively (hazard ratio, 0.88; 95% CI, 0.74 to 1.05). Total events and symptom burden were lower in the dapagliflozin group than in the placebo group. Results were similar among patients with a left ventricular ejection fraction of 60% or more and those with a left ventricular ejection fraction of less than 60%, and results were similar in prespecified subgroups, including patients with or without diabetes. The incidence of adverse events was similar in the two groups. Dapagliflozin reduced the combined risk of worsening heart failure or cardiovascular death among patients with heart failure and a mildly reduced or preserved ejection fraction. (Funded by AstraZeneca; DELIVER ClinicalTrials.gov number, NCT03619213.).
Bibliographie:	ObjectType-Article-2 SourceType-Scholarly Journals-1 content type line 14 ObjectType-Feature-3 ObjectType-Evidence Based Healthcare-1 ObjectType-Article-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	0028-4793 1533-4406 1533-4406
DOI:	10.1056/NEJMoa2206286