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Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction.
- Source :
-
The New England journal of medicine [N Engl J Med] 2022 Sep 22; Vol. 387 (12), pp. 1089-1098. Date of Electronic Publication: 2022 Aug 27. - Publication Year :
- 2022
-
Abstract
- Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of hospitalization for heart failure and cardiovascular death among patients with chronic heart failure and a left ventricular ejection fraction of 40% or less. Whether SGLT2 inhibitors are effective in patients with a higher left ventricular ejection fraction remains less certain.<br />Methods: We randomly assigned 6263 patients with heart failure and a left ventricular ejection fraction of more than 40% to receive dapagliflozin (at a dose of 10 mg once daily) or matching placebo, in addition to usual therapy. The primary outcome was a composite of worsening heart failure (which was defined as either an unplanned hospitalization for heart failure or an urgent visit for heart failure) or cardiovascular death, as assessed in a time-to-event analysis.<br />Results: Over a median of 2.3 years, the primary outcome occurred in 512 of 3131 patients (16.4%) in the dapagliflozin group and in 610 of 3132 patients (19.5%) in the placebo group (hazard ratio, 0.82; 95% confidence interval [CI], 0.73 to 0.92; P<0.001). Worsening heart failure occurred in 368 patients (11.8%) in the dapagliflozin group and in 455 patients (14.5%) in the placebo group (hazard ratio, 0.79; 95% CI, 0.69 to 0.91); cardiovascular death occurred in 231 patients (7.4%) and 261 patients (8.3%), respectively (hazard ratio, 0.88; 95% CI, 0.74 to 1.05). Total events and symptom burden were lower in the dapagliflozin group than in the placebo group. Results were similar among patients with a left ventricular ejection fraction of 60% or more and those with a left ventricular ejection fraction of less than 60%, and results were similar in prespecified subgroups, including patients with or without diabetes. The incidence of adverse events was similar in the two groups.<br />Conclusions: Dapagliflozin reduced the combined risk of worsening heart failure or cardiovascular death among patients with heart failure and a mildly reduced or preserved ejection fraction. (Funded by AstraZeneca; DELIVER ClinicalTrials.gov number, NCT03619213.).<br /> (Copyright © 2022 Massachusetts Medical Society.)
- Subjects :
- Benzhydryl Compounds adverse effects
Benzhydryl Compounds therapeutic use
Diabetes Mellitus, Type 2 complications
Diabetes Mellitus, Type 2 drug therapy
Glucosides adverse effects
Glucosides therapeutic use
Humans
Heart Failure complications
Heart Failure drug therapy
Heart Failure mortality
Heart Failure physiopathology
Sodium-Glucose Transporter 2 Inhibitors adverse effects
Sodium-Glucose Transporter 2 Inhibitors pharmacology
Sodium-Glucose Transporter 2 Inhibitors therapeutic use
Stroke Volume drug effects
Ventricular Function, Left drug effects
Subjects
Details
- Language :
- English
- ISSN :
- 1533-4406
- Volume :
- 387
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- The New England journal of medicine
- Publication Type :
- Academic Journal
- Accession number :
- 36027570
- Full Text :
- https://doi.org/10.1056/NEJMoa2206286