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Dapagliflozin in patients with heart failure with mildly reduced and preserved ejection fraction treated with a mineralocorticoid receptor antagonist or sacubitril/valsartan.

Publication ,  Journal Article
Yang, M; Butt, JH; Kondo, T; Jering, KS; Docherty, KF; Jhund, PS; de Boer, RA; Claggett, BL; Desai, AS; Hernandez, AF; Inzucchi, SE; Lam, CSP ...
Published in: Eur J Heart Fail
December 2022

AIMS: The effects of adding a sodium-glucose cotransporter 2 (SGLT2) inhibitor to a mineralocorticoid receptor antagonist (MRA) or an angiotensin receptor-neprilysin inhibitor (ARNI) in patients with heart failure (HF) and mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF) are uncertain, even though the use of all three drugs is recommended in recent guidelines. METHODS AND RESULTS: The efficacy and safety of dapagliflozin added to background MRA or ARNI therapy was examined in patients with HFmrEF/HFpEF enrolled in the DELIVER trial. The primary outcome was the composite of worsening HF or cardiovascular death. Of 6263 patients, 2667 (42.6%) were treated with an MRA and 301 (4.8%) with an ARNI at baseline. Patients taking either were younger, more often men and had lower systolic blood pressure and ejection fraction; they were also more likely to have prior HF hospitalization. The benefit of dapagliflozin was similar whether patients were receiving these therapies. The hazard ratio for the effect of dapagliflozin compared to placebo on the primary outcome was 0.86 (95% confidence interval [CI] 0.74-1.01) for MRA non-users versus 0.76 (95% CI 0.64-0.91) for MRA users (pinteraction  = 0.30). The corresponding values for ARNI non-users and users were 0.82 (95% CI 0.73-0.92) and 0.74 (95% CI 0.45-1.22), respectively (pinteraction  = 0.75). None of the adverse events examined was more common with dapagliflozin compared to placebo overall or in the MRA and ARNI subgroups. CONCLUSIONS: The efficacy and safety of dapagliflozin were similar, regardless of background treatment with an MRA or ARNI. SGLT2 inhibitors may be added to other treatments recommended in recent guidelines for HFmrEF/HFpEF.

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Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

December 2022

Volume

24

Issue

12

Start / End Page

2307 / 2319

Location

England

Related Subject Headings

  • Valsartan
  • Tetrazoles
  • Stroke Volume
  • Mineralocorticoid Receptor Antagonists
  • Male
  • Hypotension
  • Humans
  • Heart Failure
  • Drug Combinations
  • Cardiovascular System & Hematology
 

Citation

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Yang, M., Butt, J. H., Kondo, T., Jering, K. S., Docherty, K. F., Jhund, P. S., … McMurray, J. J. V. (2022). Dapagliflozin in patients with heart failure with mildly reduced and preserved ejection fraction treated with a mineralocorticoid receptor antagonist or sacubitril/valsartan. Eur J Heart Fail, 24(12), 2307–2319. https://doi.org/10.1002/ejhf.2722
Yang, Mingming, Jawad H. Butt, Toru Kondo, Karola S. Jering, Kieran F. Docherty, Pardeep S. Jhund, Rudolf A. de Boer, et al. “Dapagliflozin in patients with heart failure with mildly reduced and preserved ejection fraction treated with a mineralocorticoid receptor antagonist or sacubitril/valsartan.Eur J Heart Fail 24, no. 12 (December 2022): 2307–19. https://doi.org/10.1002/ejhf.2722.
Yang, Mingming, et al. “Dapagliflozin in patients with heart failure with mildly reduced and preserved ejection fraction treated with a mineralocorticoid receptor antagonist or sacubitril/valsartan.Eur J Heart Fail, vol. 24, no. 12, Dec. 2022, pp. 2307–19. Pubmed, doi:10.1002/ejhf.2722.
Yang M, Butt JH, Kondo T, Jering KS, Docherty KF, Jhund PS, de Boer RA, Claggett BL, Desai AS, Hernandez AF, Inzucchi SE, Kosiborod MN, Lam CSP, Langkilde AM, Martinez FA, Petersson M, Shah SJ, Vaduganathan M, Wilderäng U, Solomon SD, McMurray JJV. Dapagliflozin in patients with heart failure with mildly reduced and preserved ejection fraction treated with a mineralocorticoid receptor antagonist or sacubitril/valsartan. Eur J Heart Fail. 2022 Dec;24(12):2307–2319.
Journal cover image

Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

December 2022

Volume

24

Issue

12

Start / End Page

2307 / 2319

Location

England

Related Subject Headings

  • Valsartan
  • Tetrazoles
  • Stroke Volume
  • Mineralocorticoid Receptor Antagonists
  • Male
  • Hypotension
  • Humans
  • Heart Failure
  • Drug Combinations
  • Cardiovascular System & Hematology