Heart failure & cardiomyopathiesSecondary analysis
Dapagliflozin and diuretic utilization in heart failure with mildly reduced or preserved ejection fraction: the DELIVER trial
- Secondary analysis of the DELIVER randomised trial
- pre-specified subgroup analysis
Authors' conclusion
In patients with heart failure with mildly reduced or preserved ejection fraction, the clinical benefits of dapagliflozin relative to placebo were consistent across a wide range of diuretic categories and doses with a similar safety profile. Treatment with dapagliflozin significantly reduced new loop diuretic requirement over time.
Study context
- Population
- HF with mildly reduced or preserved EF, by background diuretic use (no diuretic, non-loop diuretic, loop diuretic furosemide-equivalent <40, 40, >40 mg)
- Participants
- 6,263 participants
- Comparison
- Dapagliflozin vs placebo by background diuretic therapy
- Primary endpoint
- Primary composite outcome, by diuretic use category and loop diuretic dose
Primary result
As reported in the abstract
Primary composite outcome by diuretic subgroup
Benefit of dapagliflozin consistent by diuretic use categories
Pinteraction = 0.64
Benefit of dapagliflozin consistent by loop diuretic dose
Pinteraction = 0.57
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| New initiation of loop diuretics · reduced by 32% | 0.68 (0.55–0.84) | P < 0.001 | |
| Loop diuretic discontinuations/disruptions | 0.98 (0.86–1.13) | P = 0.83 | |
| 0.512Hazard ratio (log scale) |
| Outcome | net difference (%) (95% CI) | P value | |
|---|---|---|---|
| First sustained loop diuretic dose increases vs decreases · fewer increases, more decreases with dapagliflozin | −6.5 (−9.4 to −3.6) | P < 0.001 | |
| −10−505Difference, % (linear scale) |
| Outcome | placebo-corrected treatment effect (mg/year) (95% CI) | P value |
|---|---|---|
| Mean loop diuretic dose over time | −2.5 (−1.5 to −3.7) | P < 0.001 |
- Mean loop diuretic dose over time: dose increased over time with placebo; attenuated with dapagliflozin
Diuretic use at baseline
- No diuretic
- 683 (10.9%)
- Non-loop diuretic
- 769 (12.3%)
- Loop diuretic
- 4811 (76.8%)
Safety
Serious adverse events
- Similar between dapagliflozin and placebo, irrespective of diuretic use or dosing
Original publication
Dapagliflozin and diuretic utilization in heart failure with mildly reduced or preserved ejection fraction: the DELIVER trial. Eur Heart J. Published 23 May 2023. doi:10.1093/eurheartj/ehad283
Summarised from the published abstract; every number is checked against it