Heart failure & cardiomyopathies
Dapagliflozin and diuretic utilization in heart failure with mildly reduced or preserved ejection fraction: the DELIVER trial
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
Methodological detailspre-specified subgroup analysis
- Pre-specified subgroup analysis
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 diureticsReduced 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 increasesvs decreasesFewer 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.
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