Heart failure & cardiomyopathies
Association of Dapagliflozin Use With Clinical Outcomes and the Introduction of Uric Acid–Lowering Therapy and Colchicine in Patients With Heart Failure With and Without Gout: A Patient-Level Pooled Meta-analysis of DAPA-HF and DELIVER
Authors' conclusion
This post hoc analysis of 2 trials found that gout was common in HF and associated with worse outcomes. The benefit of dapagliflozin was consistent in patients with and without gout. Dapagliflozin reduced the initiation of new treatments for hyperuricemia and gout.
Study context
- Population
- Patients with heart failure (HF) (NYHA II–IV, elevated NT-proBNP), LVEF ≤40% (DAPA-HF) or >40% (DELIVER)with gout history available
- Participants
- 11,005 patients
- Comparison
- Dapagliflozin vs placebo in HF patients with and without gout
- Goutn = 1,117
- No goutn = 9,888reference
- Primary endpoint
- Composite of:
- Worsening HF
- CV death
Methodological details2 phase 3 RCTs, 26 countries, subgroup analysis by gout history, Data analysed September 2022 to December 2022
- 2 phase 3 RCTs
- 26 countries
- Subgroup analysis by gout history
- Data analysed September 2022 to December 2022
Primary result
As reported in the abstract
Worsening HF or CV death, by gout history
Dapagliflozin vs PlaceboHazard ratio (95% CI)
Gout
0.84(0.66–1.06)
No gout
0.79(0.71–0.87)
Further findings
Per 100 person-years
| Outcome | Gout | No gout | Estimate | |
|---|---|---|---|---|
| Worsening HF or CV death, goutvs no gout | 14.7 (95% CI 13.0–16.5) | 10.5 (95% CI 10.1–11.0) | adjusted HR 1.15 (95% CI 1.01–1.31) | |
| Initiation of uric acid-lowering therapyDapagliflozinvs Placebo | HR 0.43 (95% CI 0.34–0.53) | |||
| Initiation of colchicineDapagliflozinvs Placebo | HR 0.54 (95% CI 0.37–0.80) | |||
| 0.20.5125Ratio (log scale) |
Prevalence of gout · baseline
- Overall
- 1117 (10.1%)
- LVEF ≤40%
- 10.3% (488 of 4747)
- LVEF >40%
- 10.1% (629 of 6258)
Worsening HF or CV death, gout vs no gout
- Gout also associated with higher risk of the other outcomes examined
Other outcomes, by gout history
- Effect of dapagliflozin consistent in patients with and without gout
Original publication
Association of Dapagliflozin Use With Clinical Outcomes and the Introduction of Uric Acid–Lowering Therapy and Colchicine in Patients With Heart Failure With and Without Gout: A Patient-Level Pooled Meta-analysis of DAPA-HF and DELIVER. JAMA Cardiol. Published 1 April 2023. doi:10.
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