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Dapagliflozin across the range of ejection fraction in patients with heart failure: a patient-level, pooled meta-analysis of DAPA-HF and DELIVER
Whether the sodium–glucose cotransporter 2 inhibitor dapagliflozin reduces the risk of a range of morbidity and mortality outcomes in patients with heart failure regardless of ejection fraction is unknown. A patient-level pooled meta-analysis of two trials testing dapagliflozin in participants with...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Nature Publishing Group US
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9499855/ https://www.ncbi.nlm.nih.gov/pubmed/36030328 http://dx.doi.org/10.1038/s41591-022-01971-4 |
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author | Jhund, Pardeep S. Kondo, Toru Butt, Jawad H. Docherty, Kieran F. Claggett, Brian L. Desai, Akshay S. Vaduganathan, Muthiah Gasparyan, Samvel B. Bengtsson, Olof Lindholm, Daniel Petersson, Magnus Langkilde, Anna Maria de Boer, Rudolf A. DeMets, David Hernandez, Adrian F. Inzucchi, Silvio E. Kosiborod, Mikhail N. Køber, Lars Lam, Carolyn S. P. Martinez, Felipe A. Sabatine, Marc S. Shah, Sanjiv J. Solomon, Scott D. McMurray, John J. V. |
author_facet | Jhund, Pardeep S. Kondo, Toru Butt, Jawad H. Docherty, Kieran F. Claggett, Brian L. Desai, Akshay S. Vaduganathan, Muthiah Gasparyan, Samvel B. Bengtsson, Olof Lindholm, Daniel Petersson, Magnus Langkilde, Anna Maria de Boer, Rudolf A. DeMets, David Hernandez, Adrian F. Inzucchi, Silvio E. Kosiborod, Mikhail N. Køber, Lars Lam, Carolyn S. P. Martinez, Felipe A. Sabatine, Marc S. Shah, Sanjiv J. Solomon, Scott D. McMurray, John J. V. |
author_sort | Jhund, Pardeep S. |
collection | PubMed |
description | Whether the sodium–glucose cotransporter 2 inhibitor dapagliflozin reduces the risk of a range of morbidity and mortality outcomes in patients with heart failure regardless of ejection fraction is unknown. A patient-level pooled meta-analysis of two trials testing dapagliflozin in participants with heart failure and different ranges of left ventricular ejection fraction (≤40% and >40%) was pre-specified to examine the effect of treatment on endpoints that neither trial, individually, was powered for and to test the consistency of the effect of dapagliflozin across the range of ejection fractions. The pre-specified endpoints were: death from cardiovascular causes; death from any cause; total hospital admissions for heart failure; and the composite of death from cardiovascular causes, myocardial infarction or stroke (major adverse cardiovascular events (MACEs)). A total of 11,007 participants with a mean ejection fraction of 44% (s.d. 14%) were included. Dapagliflozin reduced the risk of death from cardiovascular causes (hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.76–0.97; P = 0.01), death from any cause (HR 0.90, 95% CI 0.82–0.99; P = 0.03), total hospital admissions for heart failure (rate ratio 0.71, 95% CI 0.65–0.78; P < 0.001) and MACEs (HR 0.90, 95% CI 0.81–1.00; P = 0.045). There was no evidence that the effect of dapagliflozin differed by ejection fraction. In a patient-level pooled meta-analysis covering the full range of ejection fractions in patients with heart failure, dapagliflozin reduced the risk of death from cardiovascular causes and hospital admissions for heart failure (PROSPERO: CRD42022346524). |
format | Online Article Text |
id | pubmed-9499855 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Nature Publishing Group US |
record_format | MEDLINE/PubMed |
spelling | pubmed-94998552022-09-24 Dapagliflozin across the range of ejection fraction in patients with heart failure: a patient-level, pooled meta-analysis of DAPA-HF and DELIVER Jhund, Pardeep S. Kondo, Toru Butt, Jawad H. Docherty, Kieran F. Claggett, Brian L. Desai, Akshay S. Vaduganathan, Muthiah Gasparyan, Samvel B. Bengtsson, Olof Lindholm, Daniel Petersson, Magnus Langkilde, Anna Maria de Boer, Rudolf A. DeMets, David Hernandez, Adrian F. Inzucchi, Silvio E. Kosiborod, Mikhail N. Køber, Lars Lam, Carolyn S. P. Martinez, Felipe A. Sabatine, Marc S. Shah, Sanjiv J. Solomon, Scott D. McMurray, John J. V. Nat Med Analysis Whether the sodium–glucose cotransporter 2 inhibitor dapagliflozin reduces the risk of a range of morbidity and mortality outcomes in patients with heart failure regardless of ejection fraction is unknown. A patient-level pooled meta-analysis of two trials testing dapagliflozin in participants with heart failure and different ranges of left ventricular ejection fraction (≤40% and >40%) was pre-specified to examine the effect of treatment on endpoints that neither trial, individually, was powered for and to test the consistency of the effect of dapagliflozin across the range of ejection fractions. The pre-specified endpoints were: death from cardiovascular causes; death from any cause; total hospital admissions for heart failure; and the composite of death from cardiovascular causes, myocardial infarction or stroke (major adverse cardiovascular events (MACEs)). A total of 11,007 participants with a mean ejection fraction of 44% (s.d. 14%) were included. Dapagliflozin reduced the risk of death from cardiovascular causes (hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.76–0.97; P = 0.01), death from any cause (HR 0.90, 95% CI 0.82–0.99; P = 0.03), total hospital admissions for heart failure (rate ratio 0.71, 95% CI 0.65–0.78; P < 0.001) and MACEs (HR 0.90, 95% CI 0.81–1.00; P = 0.045). There was no evidence that the effect of dapagliflozin differed by ejection fraction. In a patient-level pooled meta-analysis covering the full range of ejection fractions in patients with heart failure, dapagliflozin reduced the risk of death from cardiovascular causes and hospital admissions for heart failure (PROSPERO: CRD42022346524). Nature Publishing Group US 2022-08-27 2022 /pmc/articles/PMC9499855/ /pubmed/36030328 http://dx.doi.org/10.1038/s41591-022-01971-4 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Analysis Jhund, Pardeep S. Kondo, Toru Butt, Jawad H. Docherty, Kieran F. Claggett, Brian L. Desai, Akshay S. Vaduganathan, Muthiah Gasparyan, Samvel B. Bengtsson, Olof Lindholm, Daniel Petersson, Magnus Langkilde, Anna Maria de Boer, Rudolf A. DeMets, David Hernandez, Adrian F. Inzucchi, Silvio E. Kosiborod, Mikhail N. Køber, Lars Lam, Carolyn S. P. Martinez, Felipe A. Sabatine, Marc S. Shah, Sanjiv J. Solomon, Scott D. McMurray, John J. V. Dapagliflozin across the range of ejection fraction in patients with heart failure: a patient-level, pooled meta-analysis of DAPA-HF and DELIVER |
title | Dapagliflozin across the range of ejection fraction in patients with heart failure: a patient-level, pooled meta-analysis of DAPA-HF and DELIVER |
title_full | Dapagliflozin across the range of ejection fraction in patients with heart failure: a patient-level, pooled meta-analysis of DAPA-HF and DELIVER |
title_fullStr | Dapagliflozin across the range of ejection fraction in patients with heart failure: a patient-level, pooled meta-analysis of DAPA-HF and DELIVER |
title_full_unstemmed | Dapagliflozin across the range of ejection fraction in patients with heart failure: a patient-level, pooled meta-analysis of DAPA-HF and DELIVER |
title_short | Dapagliflozin across the range of ejection fraction in patients with heart failure: a patient-level, pooled meta-analysis of DAPA-HF and DELIVER |
title_sort | dapagliflozin across the range of ejection fraction in patients with heart failure: a patient-level, pooled meta-analysis of dapa-hf and deliver |
topic | Analysis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9499855/ https://www.ncbi.nlm.nih.gov/pubmed/36030328 http://dx.doi.org/10.1038/s41591-022-01971-4 |
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