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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art_BUTT_Efficacy_and_safety_of_dapagliflozin_according_to_aetiology_2021.PDF (5.07 MB)
Citações na Scopus
32
Tipo de produção
article
Data de publicação
2021
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
WILEY
Autores
BUTT, Jawad H.
VERMA, Subodh
DOCHERTY, Kieran F.
PETRIE, Mark C.
INZUCCHI, Silvio E.
SCHOU, Morten
KOSIBOROD, Mikhail N.
LANGKILDE, Anna Maria
MARTINEZ, Felipe A.
Citação
EUROPEAN JOURNAL OF HEART FAILURE, v.23, n.4, p.601-613, 2021
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Aims 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.
Palavras-chave
Heart failure, Dapagliflozin, Aetiology, Randomized controlled trial
URI
https://observatorio.fm.usp.br/handle/OPI/42127
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/11
Artigos e Materiais de Revistas Científicas - ODS/03