Effects of dapagliflozin on heart failure hospitalizations according to severity of inpatient course: insights from DELIVER and DAPA-HF

Chatur, S. et al. (2023) Effects of dapagliflozin on heart failure hospitalizations according to severity of inpatient course: insights from DELIVER and DAPA-HF. European Journal of Heart Failure, (doi: 10.1002/ejhf.2912) (PMID:37210608) (Early Online Publication)

Abstract

Aims: Dapagliflozin resulted in significant and sustained reductions in first and recurrent HF hospitalizations among patients with HF across the spectrum of ejection fraction. How treatment with dapagliflozin differentially impacts hospitalization for HF of varying complexity is not well studied. Methods and Results: In the DELIVER and DAPA-HF trials, we examined the effects of dapagliflozin on adjudicated HF hospitalizations of varying complexity and hospital length of stay (LOS). HF hospitalizations requiring ICU stay, IV vasoactive therapies, invasive/non-invasive ventilation, mechanical fluid removal or MCS were categorized as complicated. The balance were classified as uncomplicated. Of the total 1209 HF hospitalizations reported in DELIVER, 71% (854) were uncomplicated and 29% (355) were complicated. Of the total 799 HF hospitalizations reported in DAPA-HF, 57% (453) were uncomplicated and 43% (346) were complicated. Relative to patients experiencing a first uncomplicated HF hospitalization, those with complicated HF hospitalizations had a significantly higher in-hospital mortality both in DELIVER (16.8% vs. 2.3%, p < 0.001) and DAPA-HF (15.1% vs. 3.8%, p < 0.001). Dapagliflozin similarly reduced total ‘uncomplicated’ (DELIVER: RR 0.67, 95% CI: 0.55–0.82 and DAPA-HF: RR 0.69, 95% CI: 0.54–0.87) and ‘complicated’ HF hospitalizations (DELIVER: 0.82, 95% CI: 0.63–1.06 and DAPA-HF: 0.75, 95% CI: 0.58–0.97). Dapagliflozin consistently reduced hospitalizations irrespective of their LOS: <5 days (DELIVER: RR 0.76; 95% CI: 0.58–0.99 and DAPA-HF: 0.58; 95%: 0.42–0.80) or ≥5 days (DELIVER: RR 0.71; 95% CI: 0.58–0.86 and DAPA-HF: 0.77; 95% CI: 0.62–0.94). Conclusion: A substantial proportion of hospitalizations (~30%–40%) among patients with HF irrespective of ejection fraction required intensification of treatment beyond standard intravenous diuretics. Such patients experienced significantly higher in-hospital mortality. Treatment with dapagliflozin consistently reduced HF hospitalizations regardless of severity of inpatient treatment course or LOS.

• Item Type: Articles
• Additional Information: The DELIVER and DAPA-HF trial were funded by AstraZeneca.
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Kondo, Dr Toru and Docherty, Dr Kieran and Jhund, Professor Pardeep and McMurray, Professor John
• Authors: Chatur, S., Kondo, T., Claggett, B. L., Docherty, K., Miao, Z. M., Desai, A. S., Jhund, P. S., de Boer, R. A., Hernandez, A. F., Inzucchi, S. E., Kosiborod, M. N., Lam, C. S. P., Martinez, F. A., Shah, S. J., Petersson, M., Langkilde, A. M., McMurray, J. J.V., Solomon, S. D., and Vaduganathan, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: European Journal of Heart Failure
• Publisher: Wiley
• ISSN: 1388-9842
• ISSN (Online): 1879-0844
• Published Online: 21 May 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in European Journal of Heart Failure 2023
• Publisher Policy: Reproduced under a Creative Commons License