Meta-analysis
Heart failure, peripheral artery disease, and dapagliflozin: a patient-level meta-analysis of DAPA-HF and DELIVER
- Patient-level pooled meta-analysis of the DAPA-HF and DELIVER randomised trials
- subgroup analysis by PAD
Authors' conclusion
The risk of worsening HF or cardiovascular death was higher in patients with PAD, as was the risk of amputation. The benefits of dapagliflozin were consistent in patients with and without PAD, and dapagliflozin did not increase the risk of amputation.
Study context
- Population
- Patients with heart failure (HF) with reduced, mildly reduced or preserved EF, with or without PADPAD history available for 11,005
- Participants
- 11,007 patients
- Comparison
- Dapagliflozin vs placebo, by PAD status
- Outcome
- Composite of:
- Worsening HF
- CV death
- Follow-up
- Median 22 months (IQR 17-30)
Pooled result
As reported in the abstract
Worsening HF or CV death, by PAD status (subgroups)
Dapagliflozin vs PlaceboHazard ratio (95% CI)
PAD
0.71(0.54–0.94)
no PAD
0.80(0.73–0.88)
Further pooled results
per 100 person-years
| Outcome | PAD | No PAD | adjusted HR (95% CI) | |
|---|---|---|---|---|
| Primary outcome rate, PAD vs no PAD (per 100 person-years) | 15.1 (95% CI 13.1–17.3) | 10.6 (95% CI 10.2–11.1) | 1.23 (1.06–1.43) | |
| 0.512Adjusted hazard ratio (log scale) |
- Primary outcome rate, PAD vs no PAD (per 100 person-years): PAD in 809 of 11 005 (7.4%)
Safety
Amputation, by PAD status · value = PAD subgroup
No PAD
- Amputation, by PAD status: interaction P = 1.00
Amputation, by PAD status
- Amputations not more common with dapagliflozin irrespective of PAD status; infection rather than ischaemia main trigger
Original publication
Heart failure, peripheral artery disease, and dapagliflozin: a patient-level meta-analysis of DAPA-HF and DELIVER. Eur Heart J. Published 23 May 2023. doi:10.1093/eurheartj/ehad276
Summarised from the published abstract; every number is checked against it