Fewer Outpatient HF Med Adjustments on Dapagliflozin: DAPA-HF
The scope of sodium-glucose cotransporter 2 (SGLT2) inhibition’s clinical advantages in DAPA-HF also can very well be greater than already most standard, suggests a prespecified secondary analysis of the coronary heart failure with diminished ejection part (HFrEF) trial.
DAPA-HF is already well-known for exhibiting a extremely most well-known 26% tumble in clinical events (P < .001) in HFrEF sufferers who got dapagliflozin (Farxiga, AstraZeneca), in contrast with placebo, no matter glycosylated hemoglobin stages. The number wished to treat (NNT) to pause one such occasion became finest 21 within the trial, which had a median 18 months apply-up.
The brand new analysis adds “outpatient intensification of coronary heart failure (HF) therapy” to the trial’s composite main cease level of cardiovascular (CV) death, HF hospitalization, and pressing HF consult with.
The following “expanded composite final result” extra inclusively accounts for a broader differ of clinically dire “worsening HF events,” in accordance to DAPA-HF researchers.
Outpatient intensification of therapy became defined as a diuretic dosage amplify — accounting for 3-fourths of instances — or new addition of an evidence-primarily based totally mostly HF medication, devour a renin-angiotensin-machine inhibitor or mineralocorticoid receptor antagonist, reported Kieran Docherty, MBChB, University of Glasgow, United Kingdom, in his presentation June 19 in a Uninteresting-Breaking Science Session all over HFA Discoveries.
For context, 8.6% of sufferers within the trial overall had such outpatient intensification of HF therapy, which itself predicted a two- to threefold elevated mortality chance in adjusted analysis. An “pressing HF consult with,” viewed in finest 0.4% of sufferers within the trial, indifferent tripled the mortality chance. An “HF hospitalization,” in about 10% of sufferers, multiplied the chance six times, noticed Docherty at his presentation.
The get HFA Discoveries convention substituted for the everyday annual scientific meeting of the Heart Failure Association (HFA) of the European Society of Cardiology, which became cancelled this year due to the the COVID-19 pandemic.
| Mortality Hazard Ratiosfor Particular person Nonfatal Worsening Heart Failure Events vs No Tournament in DAPA-HF | |
| Cease Point | HR (95% CI) |
|---|---|
| HF hospitalization | 6.21 (5.07–7.62) |
| Pressing HF consult with | 3.00 (1.39–6.48) |
| Outpatient intensification of HF therapy | 2.67 (2.03–3.52) |
| *Adjusted for randomization group, demographics, NYHA class, LVEF, physique mass index, pulse fee, systolic BP, serum creatinine and natriuretic peptide stages, history of HF hospitalization, AF, stroke, MI, and hypertension, and cardiac implantable digital rhythm tool use. | |
One in eight sufferers within the trial, overall, experienced at least in fact one of many worsening HF events, Docherty acknowledged. “These events were prognostically crucial, with an roughly threefold elevated chance of death following [such] an occasion in contrast to sufferers with out a worsening coronary heart failure occasion.”
But, he authorized, “dapagliflozin diminished the chance of worsening coronary heart failure events, in conjunction with outpatient worsening events, and cardiovascular death, in contrast with placebo.”
The dapagliflozin group showed a 16.5 per 100 patient-years fee for the expanded composite final result; the placebo group’s fee became 22.6 per 100 patient-years. The chance good buy for sufferers on dapagliflozin reached 27%; the NNT fell to 16.
The chance declined considerably, as well, for every of the expanded cease level’s four elements, Docherty noticed.
| Hazard Ratios for the Expanded Composite Consequence and its Parts, Dapagliflozin vs Placebo, in DAPA-HF | |
| Cease Point | HR (95% CI) |
|---|---|
| Expanded composite final result | 0.73 (0.65–0.82) |
| CV death | 0.82 (0.69–0.98) |
| HF hospitalization | 0.70 (0.59–0.85) |
| Pressing HF consult with | 0.43 (0.20–0.90) |
| Outpatient intensification of HF therapy | 0.74 (0.63–0.87) |
Unsurprisingly, sufferers with a worsening HF occasion had entered the trial sicker than other sufferers, Docherty authorized. They’d been in a elevated NYHA purposeful class, with greater natriuretic peptide stages, decrease systolic blood power, and additional left ventricular dysfunction, atrial fibrillation, and diabetes.
“In accordance to the outcomes of this glimpse, we also can claim that such episodes of worsening coronary heart failure are frequent; moreover, these events are linked to a elevated chance of mortality in contrast to sufferers with out a worsening coronary heart failure events,” acknowledged Yuri M. Lopatin, MD, PhD, Volgograd Bid Medical University, Russian Federation, as the invited discussant after the glimpse presentation.
Sufferers in DAPA-HF were overwhelmingly handled with guideline-directed clinical therapy at baseline, Lopatin noticed, so it would possibly perhaps most likely presumably well presumably even be expected that these with aspects indicating extra developed HF would require “extra frequent optimization of coronary heart failure therapy.”
DAPA-HF is backed by AstraZeneca. Docherty discloses that he is an employee of the University of Glasgow, which is paid by AstraZeneca for his participation within the trial. Lopatin had no disclosures.
HFA Discoveries 2020 from the Heart Failure Association (HFA) of the European Society of Cardiology: Uninteresting Breaking Science Session 6. Presented June 19, 2020.
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