Dapagliflozin across the range of ejection fraction in patients with heart failure: a patient-level, pooled meta-analysis of DAPA-HF and DELIVER.

Benzhydryl Compounds / pharmacology Diabetes Mellitus, Type 2 Glucose Glucosides Heart Failure / chemically induced Humans Sodium Stroke Volume Ventricular Function, Left

Journal

Nature medicine

ISSN: 1546-170X

Titre abrégé: Nat Med

Pays: United States

ID NLM: 9502015

Informations de publication

Date de publication:
09 2022

Historique:

received: 08 07 2022

accepted: 26 07 2022

pubmed: 28 8 2022

medline: 28 9 2022

entrez: 27 8 2022

Statut: ppublish

Résumé

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).

Identifiants

DOI: 10.1038/s41591-022-01971-4 PMID: 36030328 PMC: PMC9499855

pubmed: 36030328

doi: 10.1038/s41591-022-01971-4

pii: 10.1038/s41591-022-01971-4

pmc: PMC9499855

doi:

Substances chimiques

Benzhydryl Compounds 0

Glucosides 0

dapagliflozin 1ULL0QJ8UC

Sodium 9NEZ333N27

Glucose IY9XDZ35W2

Types de publication

Journal Article Meta-Analysis Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

1956-1964

Subventions

Organisme : NIDDK NIH HHS

ID : P30 DK045735

Pays : United States

Organisme : British Heart Foundation

ID : RE/18/6/34217

Pays : United Kingdom

Informations de copyright

Références

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