Cargando…
Dapagliflozin in heart failure with improved ejection fraction: a prespecified analysis of the DELIVER trial
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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group US
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9800271/ https://www.ncbi.nlm.nih.gov/pubmed/36522606 http://dx.doi.org/10.1038/s41591-022-02102-9 |
_version_ | 1784861260086509568 |
---|---|
author | Vardeny, Orly Fang, James C. Desai, Akshay S. Jhund, Pardeep S. Claggett, Brian Vaduganathan, Muthiah de Boer, Rudolf A. Hernandez, Adrian F. Lam, Carolyn S. P. Inzucchi, Silvio E. Martinez, Felipe A. Kosiborod, Mikhail N. DeMets, David O’Meara, Eileen Zieroth, Shelley Comin-Colet, Josep Drozdz, Jaroslaw Chiang, Chern-En Kitakaze, Masafumi Petersson, Magnus Lindholm, Daniel Langkilde, Anna Maria McMurray, John J. V. Solomon, Scott D. |
author_facet | Vardeny, Orly Fang, James C. Desai, Akshay S. Jhund, Pardeep S. Claggett, Brian Vaduganathan, Muthiah de Boer, Rudolf A. Hernandez, Adrian F. Lam, Carolyn S. P. Inzucchi, Silvio E. Martinez, Felipe A. Kosiborod, Mikhail N. DeMets, David O’Meara, Eileen Zieroth, Shelley Comin-Colet, Josep Drozdz, Jaroslaw Chiang, Chern-En Kitakaze, Masafumi Petersson, Magnus Lindholm, Daniel Langkilde, Anna Maria McMurray, John J. V. Solomon, Scott D. |
author_sort | Vardeny, Orly |
collection | PubMed |
description | 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 = 0.84, 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. |
format | Online Article Text |
id | pubmed-9800271 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Nature Publishing Group US |
record_format | MEDLINE/PubMed |
spelling | pubmed-98002712022-12-31 Dapagliflozin in heart failure with improved ejection fraction: a prespecified analysis of the DELIVER trial Vardeny, Orly Fang, James C. Desai, Akshay S. Jhund, Pardeep S. Claggett, Brian Vaduganathan, Muthiah de Boer, Rudolf A. Hernandez, Adrian F. Lam, Carolyn S. P. Inzucchi, Silvio E. Martinez, Felipe A. Kosiborod, Mikhail N. DeMets, David O’Meara, Eileen Zieroth, Shelley Comin-Colet, Josep Drozdz, Jaroslaw Chiang, Chern-En Kitakaze, Masafumi Petersson, Magnus Lindholm, Daniel Langkilde, Anna Maria McMurray, John J. V. Solomon, Scott D. Nat Med Article 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 = 0.84, 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. Nature Publishing Group US 2022-12-15 2022 /pmc/articles/PMC9800271/ /pubmed/36522606 http://dx.doi.org/10.1038/s41591-022-02102-9 Text en © The Author(s) 2022, corrected publication 2023 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 | Article Vardeny, Orly Fang, James C. Desai, Akshay S. Jhund, Pardeep S. Claggett, Brian Vaduganathan, Muthiah de Boer, Rudolf A. Hernandez, Adrian F. Lam, Carolyn S. P. Inzucchi, Silvio E. Martinez, Felipe A. Kosiborod, Mikhail N. DeMets, David O’Meara, Eileen Zieroth, Shelley Comin-Colet, Josep Drozdz, Jaroslaw Chiang, Chern-En Kitakaze, Masafumi Petersson, Magnus Lindholm, Daniel Langkilde, Anna Maria McMurray, John J. V. Solomon, Scott D. Dapagliflozin in heart failure with improved ejection fraction: a prespecified analysis of the DELIVER trial |
title | Dapagliflozin in heart failure with improved ejection fraction: a prespecified analysis of the DELIVER trial |
title_full | Dapagliflozin in heart failure with improved ejection fraction: a prespecified analysis of the DELIVER trial |
title_fullStr | Dapagliflozin in heart failure with improved ejection fraction: a prespecified analysis of the DELIVER trial |
title_full_unstemmed | Dapagliflozin in heart failure with improved ejection fraction: a prespecified analysis of the DELIVER trial |
title_short | Dapagliflozin in heart failure with improved ejection fraction: a prespecified analysis of the DELIVER trial |
title_sort | dapagliflozin in heart failure with improved ejection fraction: a prespecified analysis of the deliver trial |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9800271/ https://www.ncbi.nlm.nih.gov/pubmed/36522606 http://dx.doi.org/10.1038/s41591-022-02102-9 |
work_keys_str_mv | AT vardenyorly dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT fangjamesc dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT desaiakshays dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT jhundpardeeps dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT claggettbrian dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT vaduganathanmuthiah dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT deboerrudolfa dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT hernandezadrianf dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT lamcarolynsp dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT inzucchisilvioe dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT martinezfelipea dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT kosiborodmikhailn dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT demetsdavid dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT omearaeileen dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT zierothshelley dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT comincoletjosep dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT drozdzjaroslaw dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT chiangchernen dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT kitakazemasafumi dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT peterssonmagnus dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT lindholmdaniel dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT langkildeannamaria dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT mcmurrayjohnjv dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial AT solomonscottd dapagliflozininheartfailurewithimprovedejectionfractionaprespecifiedanalysisofthedelivertrial |