Dapagliflozin, atrial fibrillation, and heart failure with mildly reduced or preserved ejection fraction in DELIVER

Butt, J. H. et al. (2022) Dapagliflozin, atrial fibrillation, and heart failure with mildly reduced or preserved ejection fraction in DELIVER. Journal of the American College of Cardiology, 80(18), pp. 1705-1717. (doi: 10.1016/j.jacc.2022.08.718) (PMID:36041668)

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Background: Atrial fibrillation (AF) is common in heart failure (HF), is associated with worse outcomes, compared to sinus rhythm, and may modify the effects of therapy. Objectives: We examined the effects of dapagliflozin according to the presence or not of AF in the Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure trial (DELIVER). Methods: A total of 6,263 patients with HF with NYHA functional class II-IV, LVEF >40%, evidence of structural heart disease, and elevated NT-proBNP levels were randomized to dapagliflozin or placebo. Clinical outcomes, and the effect of dapagliflozin, according to AF status, were examined. The primary outcome was a composite of cardiovascular death or a worsening HF. Results: Of the 6,261 patients with data on baseline AF, 43.3% had no AF, 18.0% paroxysmal AF, and 38.7% persistent/permanent AF. The risk of the primary endpoint was higher in patients with AF, especially paroxysmal AF, driven by a higher rate of HF hospitalization: no AF, HF hospitalization rate per 100 person-years (95% CI), 4.5 (4.0-5.1); paroxysmal AF 7.5 (6.4-8.7); persistent/permanent AF 6.4 (5.7-7.1) (P<0.001). The benefit of dapagliflozin on the primary outcome was consistent across AF types: no AF, HR (95% CI) 0.89 (0.74-1.08); paroxysmal AF, 0.75 (0.58-0.97); persistent AF, 0.79 (0.66-0.95) [Pinteraction=0.49]. Consistent effects were observed for HF hospitalization, cardiovascular death, all-cause mortality, and improvement in the KCCQ-TSS. Conclusions: In DELIVER, the beneficial effects of dapagliflozin, compared with placebo, on clinical events and symptoms were consistent, irrespective of type of AF at baseline.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Butt, Mr Jawad and Kondo, Dr Toru and Jhund, Professor Pardeep and McMurray, Professor John
Authors: Butt, J. H., Kondo, T., Jhund, P. S., Comin-Colet, J., de Boer, R. A., Desai, A. S., Hernandez, A. F., Inzucchi, S. E., Janssens, S. P., Kosiborod, M. N., Lam, C. S.P., Langkilde, A. M., Lindholm, D., Martinez, F., Petersson, M., Shah, S. J., Thierer, J., Vaduganathan, M., Verma, S., Wilderäng, U., Claggett, B. C., Solomon, S. D., and McMurray, J. J.V.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Journal of the American College of Cardiology
ISSN (Online):1558-3597
Published Online:27 August 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Journal of the American College of Cardiology 80(18): 1705-1717
Publisher Policy:Reproduced under a Creative Commons License

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