Heart failure & cardiomyopathies

Impact of COVID-19 in Patients with Heart Failure with Mildly Reduced or Preserved Ejection Fraction Enrolled in the DELIVER Trial

Eur J Heart FailPublished Secondary analysis of the DELIVER randomised trial

Primary result · All-cause deathResult — go to the resultAdjusted hazard ratio 8.60 95% CI 7.18–10.30

Authors' conclusion

COVID-19 was common, with >50% of cases leading to hospitalization or death. Treatment benefits of dapagliflozin persisted when censoring at COVID-19 diagnosis and pandemic onset. Patients surviving COVID-19 had a high early residual risk.

Study context

Population
Chronic HF with mildly reduced or preserved EF (HFmrEF/HFpEF) randomised to dapagliflozin or placebo
Participants
6,263 participants
Comparison
Participants with vs without COVID-19
  • COVID-19n = 589
Primary endpoint
Death after COVID-19 diagnosis vs participants without COVID-19
Follow-up
12 months following diagnosis
Methodological detailsmulticentre, 350 sites in 20 countries
  • Multicentre
  • 350 sites in 20 countries

Primary result

All-cause death

Adjusted hazard ratio

8.60

95% CI 7.18–10.30

By group

COVID-19vs No COVID-19
aHR 8.60 (95% CI 7.18–10.30)

As reported in the abstract

Further findings

OutcomeEstimate
All-cause death in COVID-19 survivorsvs all participants · 12 months following diagnosisn = 458 survivors; fatal COVID-19 events excludedaHR 2.46 (95% CI 1.83–3.33)
CV death/worsening HF, dapagliflozin vs placebo (sensitivity)Dapagliflozinvs PlaceboCensored at COVID-19 diagnosisHR 0.81 (95% CI 0.72–0.91)
CV death/worsening HF, dapagliflozin vs placebo (sensitivity)Dapagliflozinvs PlaceboCensored at pandemic onsetHR 0.72 (95% CI 0.58–0.89)

Incidence of COVID-19

Developed COVID-19
589 (9.4%)
Required/prolonged hospitalization
307 (52%)
Deaths adjudicated definitely/possibly COVID-19-related
155 (15% of all deaths)
COVID-19 cases and deaths did not differ by randomized assignment

Death rate by time after diagnosis (COVID-19)

0-3 months, /100 participant-years
153.5 (95% CI 130.3-180.8)
3-6 months, /100 participant-years
12.6 (95% CI 6.6-24.3)

Safety

Diabetic ketoacidosis or major hypoglycaemia within 30 days of COVID-19

No events

Original publication

Impact of COVID-19 in Patients with Heart Failure with Mildly Reduced or Preserved Ejection Fraction Enrolled in the DELIVER Trial. Eur J Heart Fail. Published 9 October 2023. doi:10.1002/ejhf.3043

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