Effects of dapagliflozin in heart failure with reduced ejection fraction, and chronic obstructive pulmonary disease: an analysis of DAPA-HF

Dewan, P. et al. (2021) Effects of dapagliflozin in heart failure with reduced ejection fraction, and chronic obstructive pulmonary disease: an analysis of DAPA-HF. European Journal of Heart Failure, 23(4), pp. 632-643. (doi: 10.1002/ejhf.2083) (PMID:33368858) (PMCID:PMC8247863)

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Abstract

Aims: Chronic obstructive pulmonary disease (COPD) is an important comorbidity in HFrEF, associated with worse outcomes and often suboptimal treatment because of under‐prescription of beta‐blockers. Consequently, additional effective therapies are especially relevant in patients with COPD. To examine outcomes related to COPD in a post hoc analysis of the Dapagliflozin And Prevention of Adverse‐outcomes in Heart Failure trial (DAPA‐HF). Methods and Results: We examined whether the effects of dapagliflozin in DAPA‐HF were modified by COPD status. The primary outcome was the composite of an episode of worsening heart failure (HF) event or cardiovascular (CV) death. 585 (12.3%) of the 4744 patients randomized had a history of COPD. Patients with COPD were more likely to be older men with a history of smoking, worse renal function, and higher baseline NT‐proBNP, and less likely to be treated with a beta‐blocker or mineralocorticoid receptor antagonist. The incidence of the primary outcome was higher in patients with COPD than in those without 18.9 (95% CI 16.0–22.2) versus 13.0 (12.1–14.0) per 100 person‐years; hazard ratio (HR) for COPD versus no COPD 1.44 (1.21–1.72), P<0.001. The effect of dapagliflozin, compared with placebo, on the primary outcome, was consistent in patients with (HR 0.67 [95%CI 0.48–0.93]) and without COPD (0.76 [0.65–0.87]); interaction p‐value 0.47. Conclusions: In DAPA‐HF, one‐in‐eight patients with HFrEF had concomitant COPD. Participants with COPD had a higher risk of the primary outcome. The benefit of dapagliflozin on all prespecified outcomes was consistent in patients with and without COPD.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Docherty, Dr Kieran and Jhund, Dr Pardeep and Dewan, Dr Pooja and McMurray, Professor John and Petrie, Professor Mark
Authors: Dewan, P., Docherty, K. F., Bengtsson, O., de Boer, R. A., Desai, A. S., Drozdz, J., Hawkins, N. M., Inzucchi, S. E., Kitakaze, M., Køber, L., Kosiborod, M. N., Langkilde, A. M., Lindholm, D., Martinez, F. A., Merkely, B., Petrie, M. C., Ponikowski, P., Sabatine, M. S., Schou, M., Sjöstrand, M., Solomon, S. D., Verma, S., Jhund, P. S., and McMurray, J. J.V.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:European Journal of Heart Failure
Publisher:Wiley
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:23 December 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in European Journal of Heart Failure 2020
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science