Heart failure & cardiomyopathiesSecondary analysis
Impact of COVID-19 in Patients with Heart Failure with Mildly Reduced or Preserved Ejection Fraction Enrolled in the DELIVER Trial
- Secondary analysis of the DELIVER randomised trial
- multicentre
- 350 sites in 20 countries
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
Primary result
All-cause death
Adjusted hazard ratio
8.60
95% CI 7.18–10.30
By group
COVID-19 vs No COVID-19
aHR 8.60 (95% CI 7.18–10.30)
As reported in the abstract
Further findings
| Outcome | Estimate | |
|---|---|---|
| All-cause death in COVID-19 survivors vs all participants · 12 months following diagnosis · n = 458 survivors; fatal COVID-19 events excluded | aHR 2.46 (95% CI 1.83–3.33) | |
| CV death/worsening HF, dapagliflozin vs placebo (sensitivity) — Dapagliflozin vs Placebo · censored at COVID-19 diagnosis | HR 0.81 (95% CI 0.72–0.91) | |
| CV death/worsening HF, dapagliflozin vs placebo (sensitivity) — Dapagliflozin vs Placebo · censored at pandemic onset | HR 0.72 (95% CI 0.58–0.89) | |
| 0.20.5125Ratio (log scale) |
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
Summarised from the published abstract; every number is checked against it