Heart failure & cardiomyopathiesSecondary analysis
Renal and Blood Pressure Effects of Dapagliflozin in Recently Hospitalized Patients with Heart Failure with mildly reduced or Preserved Ejection Fraction: Insights from the DELIVER Trial
- Secondary analysis of the DELIVER randomised trial
- placebo-controlled
- subgroup analysis by recent heart failure (HF) hospitalization
Authors' conclusion
In patients recently hospitalized with HF, initiation of dapagliflozin had minimal effects on blood pressure and did not increase renal or hypovolaemic serious adverse events, yet afforded long-term cardiovascular and kidney protective effects.
Study context
- Population
- Patients with HF with mildly reduced or preserved EF, with and without HF hospitalization within 30 days of randomization654 recently hospitalized
- Comparison
- Dapagliflozin vs Placebo
Primary result
As reported in the abstract
Acute placebo-corrected eGFR change, recently hospitalized vs not
Dapagliflozin vs PlaceboPlacebo-corrected eGFR change, ml/min/1.73 m2 (CI)
recently hospitalized
−2.0(−4.1, +0.1)
no recent hospitalization
−3.4(−3.9 to −2.9)
Further findings
| Outcome | SBP change (mmHg) |
|---|---|
| SBP change, recently hospitalized vs not (subgroup) · 1 month — Dapagliflozin vs Placebo · recently hospitalized | −1.3 |
| SBP change, recently hospitalized vs not (subgroup) · 1 month — Dapagliflozin vs Placebo · no recent hospitalization | −1.8 |
- SBP change, recently hospitalized vs not (subgroup): interaction P = 0.64
All-cause, cardiac-related and HF-specific hospitalizations, by recent HF hospitalization (subgroup)
- Dapagliflozin consistently reduced risk irrespective of recent HF hospitalization
- all-cause interaction P = 0.20
- cardiac-related interaction P = 0.75
- HF-specific interaction P = 0.90
Chronic estimated glomerular filtration rate (eGFR) decline, by recent HF hospitalization (subgroup)
- Slowing of chronic eGFR decline similar regardless of recent hospitalization
- interaction P = 0.57
Baseline eGFR, recently hospitalized vs not
- Recently hospitalized: median 55 (IQR 43, 71) ml/min/1.73 m²
- No recent hospitalization: median 60 (IQR 47, 75) ml/min/1.73 m²
Safety
Renal or hypovolaemic serious adverse events
- No treatment-related excess, irrespective of recent HF hospitalization
Original publication
Renal and Blood Pressure Effects of Dapagliflozin in Recently Hospitalized Patients with Heart Failure with mildly reduced or Preserved Ejection Fraction: Insights from the DELIVER Trial. Eur J Heart Fail. Published 8 June 2023. doi:10.1002/ejhf.2915
Summarised from the published abstract; every number is checked against it