Heart failure, chronic obstructive pulmonary disease and efficacy and safety of dapagliflozin in HFmrEF/HFpEF: insights from DELIVER

Butt, J. H. et al. (2023) Heart failure, chronic obstructive pulmonary disease and efficacy and safety of dapagliflozin in HFmrEF/HFpEF: insights from DELIVER. European Journal of Heart Failure, (doi: 10.1002/ejhf.3000) (PMID:37634087) (Early Online Publication)

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Introduction: Chronic obstructive pulmonary disease (COPD) is common in heart failure (HF) with a mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) and is associated with worse outcomes. Methods and results: In a prespecified analysis of DELIVER, we investigated the relationship between COPD status and outcomes, and the efficacy and safety of dapagliflozin, compared with placebo, according to COPD status. Patients with severe pulmonary disease (including COPD) were excluded from the trial. The primary outcome was a composite of cardiovascular death or worsening HF. Of the 6261 patients with data on baseline COPD status, 694 (11.1%) had a known history of this condition. The risk of the primary endpoint was higher in patients with mild-to-moderate COPD compared with those without COPD (adjusted HR: 1.28 (95% CI: 1.08–1.51). The benefit of dapagliflozin on the primary outcome was consistent irrespective of COPD status: no COPD, HR: 0.82 (95% CI: 0.72–0.93); COPD, HR: 0.82 (95% CI: 0.62–1.10) (Pinteraction = 0.98). Consistent effects were observed for HF, cardiovascular, and all-cause hospitalization, and deaths, and composites of these. Dapagliflozin, as compared with placebo, improved the KCCQ scores from baseline to 8 months to a similar extent in patients with and without mild-to-moderate COPD (Pinteraction ≥0.63). Adverse events and treatment discontinuation were not more frequent with dapagliflozin than with placebo irrespective of COPD status. Conclusions: Mild-to-moderate COPD is common in patients with HFmrEF/HFpEF and is associated with worse outcomes. The beneficial effects of dapagliflozin compared with placebo on clinical events and symptoms were consistent, regardless of COPD status.

Item Type:Articles
Status:Early Online Publication
Glasgow Author(s) Enlighten ID:Butt, Mr Jawad and Kondo, Dr Toru and Jhund, Professor Pardeep and McMurray, Professor John
Authors: Butt, J. H., Lu, H., Kondo, T., Bachus, E., de Boer, R. A., Inzucchi, S. E., Jhund, P. S., Kosiborod, M. N., Lam, C. S.P., Martinez, F. A., Vaduganathan, M., Solomon, S. D., and McMurray, J. J.V.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:European Journal of Heart Failure
ISSN (Online):1879-0844
Published Online:26 August 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

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