Cardio-renal-metabolic overlap, outcomes, and dapagliflozin in heart failure with mildly reduced or preserved ejection fraction

Ostrominski, J. W. et al. (2023) Cardio-renal-metabolic overlap, outcomes, and dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. JACC: Heart Failure, 11(11), pp. 1491-1503. (doi: 10.1016/j.jchf.2023.05.015) (PMID:37226448)

Abstract

Background Cardio-renal-metabolic (CRM) conditions are individually common among patients with heart failure (HF), but the prevalence and influence of overlapping CRM conditions in this population have not been well-studied. Objectives This study aims to evaluate the impact of overlapping CRM conditions on clinical outcomes and treatment effects of dapagliflozin in HF. Methods In this post hoc analysis of DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure), we evaluated the prevalence of comorbid CRM conditions (atherosclerotic cardiovascular disease, chronic kidney disease, and type 2 diabetes), their impact on the primary outcome (cardiovascular death or worsening HF), and treatment effects of dapagliflozin by CRM status. Results Among 6,263 participants, 1,952 (31%), 2,245 (36%), and 1,236 (20%) had 1, 2, and 3 additional CRM conditions, respectively. HF alone was uncommon (13%). Greater CRM multimorbidity was associated with older age, higher body mass index, longer-duration HF, worse health status, and lower left ventricular ejection fraction. Risk of the primary outcome increased with higher CRM overlap, with 3 CRM conditions independently associated with highest risk of primary events (adjusted HR: 2.16 [95% CI: 1.72-2.72]; P < 0.001) compared with HF alone. Relative benefits of dapagliflozin on the primary outcome were consistent irrespective of the type of CRM overlap (Pinteraction = 0.773) and by the number of CRM conditions (Pinteraction = 0.734), with greatest absolute benefits among those with highest CRM multimorbidity. Estimated 2-year numbers needed to treat with dapagliflozin to prevent 1 primary event were approximately 52, 39, 33, and 24 for participants with 0, 1, 2, and 3 additional CRM conditions at baseline, respectively. Adverse events between treatment arms were similar across the CRM spectrum. Conclusions CRM multimorbidity was common and associated with adverse outcomes among patients with HF and left ventricular ejection fraction >40% in DELIVER. Dapagliflozin was safe and effective across the CRM spectrum, with greater absolute benefits among those with highest CRM overlap (Dapagliflozin Evaluation to Improve the LIVEs of Patients With Preserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Jhund, Professor Pardeep and McMurray, Professor John
• Authors: Ostrominski, J. W., Thierer, J., Claggett, B. L., Miao, Z. M., Desai, A. S., Jhund, P. S., Kosiborod, M. N., Lam, C. S.P., Inzucchi, S. E., Martinez, F. A., de Boer, R. A., Hernandez, A. F., 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: JACC: Heart Failure
• Publisher: Elsevier on behalf of the American College of Cardiology Foundation
• ISSN: 2213-1779
• ISSN (Online): 2213-1787
• Published Online: 24 May 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in JACC: Heart Failure 11(11):1491-1503
• Publisher Policy: Reproduced under a Creative Commons licence