Heart failure (HF) patients who have recently been hospitalized are at significant risk of dying and being readmitted. For a study, individuals with HF with modestly decreased or retained left ventricular ejection fraction (LVEF) who were included during or after hospitalization were evaluated by researchers for clinical outcomes and responses to dapagliflozin.
Patients with HF with LVEF > 40% were randomized to receive dapagliflozin or a placebo in the DELIVER (Dapagliflozin Evaluation to Improve the LIVES of Patients With PReserved Ejection Fraction Heart Failure) experiment. DELIVER allowed clinically stable patients who were not receiving intravenous HF treatments to be randomized during or shortly after being admitted to the hospital for HF. The investigation was conducted to see whether a recent HF hospitalization affected the risk of clinical events or how the body responded to dapagliflozin. The two main outcomes were cardiovascular mortality or a worsening HF episode.
About 654 (10.4%) of the 6,263 patients in DELIVER were randomly assigned either during their hospital stay for HF or within 30 days of release. After multivariable adjustment (HR: 1.88; 95% CI: 1.60-2.21; P<0.001), a recent HF hospitalization was linked to a higher risk of the main outcome. In patients who had recently been hospitalized, dapagliflozin decreased the main outcome by 22% (HR: 0.78; 95% CI: 0.60-1.03) and by 18% in patients who had not recently been hospitalized (HR: 0.82; 95% CI: 0.72-0.94; Pinteraction= 0.71). In recently hospitalized patients, rates of adverse events such as volume depletion, diabetic ketoacidosis, or renal events were comparable with dapagliflozin & placebo.
Patients with and without a history of recent HF hospitalization saw similar reductions in the risk of worsening HF or cardiovascular mortality while taking dapagliflozin. In patients with modestly reduced/preserved LVEF, starting dapagliflozin during/shortly after HF hospitalization looks safe & beneficial.
Reference: jacc.org/doi/10.1016/j.jacc.2022.07.021
