Heart failure & cardiomyopathiesSecondary analysis
Dapagliflozin and Mode of Death in Heart Failure With Improved Ejection Fraction
- Post hoc analysis of the DELIVER randomised trial
- blinded end point adjudication
Authors' conclusion
The findings in this study support current guideline recommendations for use of sodium-glucose transport protein 2 inhibitor therapy, and further suggest that the addition of a sodium-glucose transport protein 2 inhibitor therapy to other guideline-directed medical therapies may help reduce cardiovascular mortality in patients with HFimpEF.
Study context
- Population
- Patients with HF, left ventricular ejection fraction (LVEF) >40%, NYHA class II–IV symptoms and elevated natriuretic peptides in the DELIVER trialDELIVER post hoc
- Comparison
- Mode of death in heart failure with improved ejection fraction (HFimpEF) vs LVEF consistently >40%; dapagliflozin vs placebo
- HFimpEFn = 1,151
- LVEF consistently >40%n = 5,112reference
- Primary endpoint
- Mode of death by HFimpEF status, and association of randomised treatment with cause-specific death (Cox regression)
Primary result
As reported in the abstract
Mode of death
| Group | Value | Noncardiovascular death | CV death |
|---|---|---|---|
| HFimpEF | 16.5% | 103 of 190 [54%] | 87 of 190 [46%] |
| LVEF consistently >40% | 16.3% | 428 of 833 [51%] | 405 of 833 [49%] |
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Sudden death in HFimpEF, dapagliflozin vs placebo | 0.38 (0.18–0.79) | P for interaction = 0.01 | |
| 0.20.5125Hazard ratio (log scale) |
- Sudden death in HFimpEF, dapagliflozin vs placebo: interaction P = .01
Cause of CV death in HFimpEF
- Sudden death
- 36 of 190 events [19%]
- HF-related death
- 29 of 190 events [15%]
Sudden death in HFimpEF, dapagliflozin vs placebo
- Dapagliflozin associated with lower rates of CV death vs placebo in HFimpEF, primarily due to lower rates of sudden death
Original publication
Dapagliflozin and Mode of Death in Heart Failure With Improved Ejection Fraction. JAMA Cardiol. Published 1 March 2024. doi:10.1001/jamacardio.2023.5318
Summarised from the published abstract; every number is checked against it