Dapagliflozin and Diuretic Use in Patients With Heart Failure and Reduced Ejection Fraction in DAPA-HF.

Abstract

BACKGROUND:

In the DAPA-HF trial (Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure), the sodium-glucose cotransporter 2 inhibitor dapagliflozin reduced the risk of worsening heart failure and death in patients with heart failure and reduced ejection fraction. We examined the efficacy and tolerability of dapagliflozin in relation to background diuretic treatment and change in diuretic therapy after randomization to dapagliflozin or placebo.

METHODS:

We examined the effects of study treatment in the following subgroups: no diuretic and diuretic dose equivalent to furosemide <40, 40, and >40 mg daily at baseline. We examined the primary composite end point of cardiovascular death or a worsening heart failure event and its components, all-cause death and symptoms.

RESULTS:

Of 4616 analyzable patients, 736 (15.9%) were on no diuretic, 1311 (28.4%) were on <40 mg, 1365 (29.6%) were on 40 mg, and 1204 (26.1%) were taking >40 mg. Compared with placebo, dapagliflozin reduced the risk of the primary end point across each of these subgroups: hazard ratios were 0.57 (95% CI, 0.36-0.92), 0.83 (95% CI, 0.63-1.10), 0.77 (95% CI, 0.60-0.99), and 0.78 (95% CI, 0.63-0.97), respectively (P for interaction=0.61). The hazard ratio in patients taking any diuretic was 0.78 (95% CI, 0.68-0.90). Improvements in symptoms and treatment toleration were consistent across the diuretic subgroups. Diuretic dose did not change in most patients during follow-up, and mean diuretic dose did not differ between the dapagliflozin and placebo groups after randomization.

CONCLUSIONS:

The efficacy and safety of dapagliflozin were consistent across the diuretic subgroups examined in DAPA-HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03036124.

• Authors: Alice M Jackson, Pooja Dewan, Inder S Anand, Jan Bělohlávek, Olof Bengtsson, Rudolf A de Boer, Michael Böhm, David W Boulton, Vijay K Chopra, David L DeMets, Kieran F Docherty, Andrej Dukát, Peter J Greasley, Jonathan G Howlett, Silvio E Inzucchi, Tzvetana Katova, Lars Køber, Mikhail N Kosiborod, Anna Maria Langkilde, Daniel Lindholm, Charlotta E A Ljungman, Felipe A Martinez, Eileen O'Meara, Marc S Sabatine, Mikaela Sjöstrand, Scott D Solomon, Sergey Tereshchenko, Subodh Verma, Pardeep S Jhund, John J V McMurray
• Journal: Circulation (Circulation) Vol. 142 Issue 11 Pg. 1040-1054 (09 15 2020) ISSN: 1524-4539 [Electronic] United States
• PMID: 32673497 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Benzhydryl Compounds
• Diuretics
• Glucosides
• dapagliflozin

Topics

• Aged
• Aged, 80 and over
• Benzhydryl Compounds (administration & dosage)
• Diuretics (administration & dosage)
• Female
• Glucosides (administration & dosage)
• Heart Failure (drug therapy, physiopathology)
• Humans
• Male
• Middle Aged
• Stroke Volume (drug effects)