Efficacy and safety of dapagliflozin according to aetiology in heart failure with reduced ejection fraction: insights from the DAPA-HF trial

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorBUTT, Jawad H.
dc.contributor.authorNICOLAU, Jose C.
dc.contributor.authorVERMA, Subodh
dc.contributor.authorDOCHERTY, Kieran F.
dc.contributor.authorPETRIE, Mark C.
dc.contributor.authorINZUCCHI, Silvio E.
dc.contributor.authorSCHOU, Morten
dc.contributor.authorKOSIBOROD, Mikhail N.
dc.contributor.authorLANGKILDE, Anna Maria
dc.contributor.authorMARTINEZ, Felipe A.
dc.contributor.authorPONIKOWSKI, Piotr
dc.contributor.authorSABATINE, Marc S.
dc.contributor.authorSJOSTRAND, Mikaela
dc.contributor.authorSOLOMON, Scott D.
dc.contributor.authorBENGTSSON, Olof
dc.contributor.authorJHUND, Pardeep S.
dc.contributor.authorMCMURRAY, John J. V.
dc.contributor.authorKOBER, Lars
dc.date.accessioned2021-10-20T13:56:18Z
dc.date.available2021-10-20T13:56:18Z
dc.date.issued2021
dc.description.abstractAims We examined the efficacy and safety of dapagliflozin, compared with placebo, according to aetiology in patients with heart failure (HF) with reduced ejection fraction (HFrEF) enrolled in the Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure trial (DAPA-HF). Methods and results Aetiology was investigator-reported and categorized as ischaemic or non-ischaemic. The primary outcome was the composite of an episode of worsening HF or cardiovascular death. A total of 4744 patients were randomized in DAPA-HF, of whom 2674 (56.4%) patients had an ischaemic aetiology. Participants with an ischaemic aetiology had a higher risk of cardiovascular mortality [hazard ratio (HR) 1.35, 95% confidence interval (CI) 1.13-1.63], but lower risk of HF hospitalization (HR 0.83, 95% CI 0.70- 0.98) than non-ischaemic patients. Compared with placebo, dapagliflozin reduced the risk of worsening HF or cardiovascular death to a similar extent in both patients with ischaemic and non-ischaemic aetiology (HR 0.77, 95% CI 0.65- 0.92, and HR 0.71, 95% CI 0.58- 0.87, respectively; P for interaction = 0.55). Consistent benefits were observed for the components of the primary outcome and all-cause mortality. Dapagliflozin, as compared with placebo, increased the proportion of patients with an improvement of Kansas City CardiomyopathyQuestionnaire total symptom score (KCCQ-TSS) of >=Psi 5 points (P for interaction = 0.32) and decreased the proportion with a deterioration in KCCQ-TSS of >= 5 points (P for interaction = 0.76), irrespective of aetiology. Study drug discontinuation and serious adverse events were similar according to treatment groups, irrespective of aetiology. Conclusions Dapagliflozin reduced the risk of worsening HF and death, and improved symptoms, similarly in patients with ischaemic and non-ischaemic aetiology. In addition, dapagliflozin was safe and well-tolerated, irrespective of aetiology.eng
dc.description.indexMEDLINEeng
dc.description.sponsorshipAstraZenecaAstraZeneca
dc.description.sponsorshipBritish Heart Foundation Centre of Research ExcellenceBritish Heart Foundation [RE/18/6/34217]
dc.identifier.citationEUROPEAN JOURNAL OF HEART FAILURE, v.23, n.4, p.601-613, 2021
dc.identifier.doi10.1002/ejhf.2124
dc.identifier.eissn1879-0844
dc.identifier.issn1388-9842
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/42127
dc.language.isoeng
dc.publisherWILEYeng
dc.relation.ispartofEuropean Journal of Heart Failure
dc.rightsrestrictedAccesseng
dc.rights.holderCopyright WILEYeng
dc.subjectHeart failureeng
dc.subjectDapagliflozineng
dc.subjectAetiologyeng
dc.subjectRandomized controlled trialeng
dc.subject.othercardiac-arresteng
dc.subject.othersudden-deatheng
dc.subject.otherdefibrillatoreng
dc.subject.otherepidemiologyeng
dc.subject.othersurvivaleng
dc.subject.otheroutcomeseng
dc.subject.othercanagliflozineng
dc.subject.otherimplantationeng
dc.subject.othermechanismseng
dc.subject.othercarvediloleng
dc.subject.wosCardiac & Cardiovascular Systemseng
dc.titleEfficacy and safety of dapagliflozin according to aetiology in heart failure with reduced ejection fraction: insights from the DAPA-HF trialeng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.affiliation.countryDinamarca
hcfmusp.affiliation.countryEstados Unidos
hcfmusp.affiliation.countrySuécia
hcfmusp.affiliation.countryArgentina
hcfmusp.affiliation.countryPolônia
hcfmusp.affiliation.countryAustrália
hcfmusp.affiliation.countryEscócia
hcfmusp.affiliation.countryCanadá
hcfmusp.affiliation.countryisodk
hcfmusp.affiliation.countryisoca
hcfmusp.affiliation.countryisogb
hcfmusp.affiliation.countryisoau
hcfmusp.affiliation.countryisose
hcfmusp.affiliation.countryisoar
hcfmusp.affiliation.countryisopl
hcfmusp.affiliation.countryisous
hcfmusp.author.externalBUTT, Jawad H.:Copenhagen Univ Hosp, Dept Cardiol, Rigshosp, Copenhagen, Denmark
hcfmusp.author.externalVERMA, Subodh:Univ Toronto, St Michaels Hosp, Div Cardiac Surg, Toronto, ON, Canada
hcfmusp.author.externalDOCHERTY, Kieran F.:Univ Glasgow, BHF Cardiovasc Res Ctr, Glasgow, Scotland
hcfmusp.author.externalPETRIE, Mark C.:Univ Glasgow, BHF Cardiovasc Res Ctr, Glasgow, Scotland
hcfmusp.author.externalINZUCCHI, Silvio E.:Yale Sch Med, Sect Endocrinol, New Haven, CT USA; Herlev Gentofte Univ Hosp, Dept Cardiol, Herlev, Denmark
hcfmusp.author.externalKOSIBOROD, Mikhail N.:Univ Missouri, St Lukes Mid Amer Heart Inst, Kansas City, MO 64110 USA; Univ New South Wales, George Inst Global Hlth, Sydney, NSW, Australia
hcfmusp.author.externalLANGKILDE, Anna Maria:AstraZeneca, Late Stage Dev Cardiovasc Renal & Metab, BioPharmaceut R&D, Gothenburg, Sweden
hcfmusp.author.externalMARTINEZ, Felipe A.:Univ Nacl Cordoba, Cordoba, Argentina
hcfmusp.author.externalPONIKOWSKI, Piotr:Wroclaw Med Univ, Univ Hosp, Ctr Heart Dis, Wroclaw, Poland
hcfmusp.author.externalSABATINE, Marc S.:Brigham & Womens Hosp, TIMI Study Grp, 75 Francis St, Boston, MA 02115 USA
hcfmusp.author.externalSJOSTRAND, Mikaela:AstraZeneca, Late Stage Dev Cardiovasc Renal & Metab, BioPharmaceut R&D, Gothenburg, Sweden
hcfmusp.author.externalSOLOMON, Scott D.:Brigham & Womens Hosp, Div Cardiovasc Med, 75 Francis St, Boston, MA 02115 USA
hcfmusp.author.externalBENGTSSON, Olof:AstraZeneca, Late Stage Dev Cardiovasc Renal & Metab, BioPharmaceut R&D, Gothenburg, Sweden
hcfmusp.author.externalJHUND, Pardeep S.:Univ Glasgow, BHF Cardiovasc Res Ctr, Glasgow, Scotland
hcfmusp.author.externalMCMURRAY, John J. V.:Univ Glasgow, BHF Cardiovasc Res Ctr, Glasgow, Scotland
hcfmusp.author.externalKOBER, Lars:Copenhagen Univ Hosp, Dept Cardiol, Rigshosp, Copenhagen, Denmark
hcfmusp.citation.scopus32
hcfmusp.contributor.author-fmusphcJOSE CARLOS NICOLAU
hcfmusp.description.beginpage601
hcfmusp.description.endpage613
hcfmusp.description.issue4
hcfmusp.description.volume23
hcfmusp.origemWOS
hcfmusp.origem.pubmed33594755
hcfmusp.origem.scopus2-s2.0-85102243941
hcfmusp.origem.wosWOS:000627066500001
hcfmusp.publisher.cityHOBOKENeng
hcfmusp.publisher.countryUSAeng
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