Dapagliflozin in heart failure with improved ejection fraction: a prespecified analysis of the DELIVER trial.

Journal Article (Journal Article)

With modern treatments for heart failure with reduced ejection fraction (EF), indicative of impaired cardiac systolic function, patients may exhibit an increase in EF. Limited data are available regarding the clinical management of this growing population, categorized as heart failure with improved EF (HFimpEF), which has a high event rate and has been excluded from virtually all prior heart failure outcomes trials. In a prespecified analysis of the DELIVER trial ( NCT03619213 ), of a total of 6,263 participants with symptomatic heart failure and a left ventricular EF >40%, 1,151 (18%) had HFimpEF, defined as patients whose EF improved from ≤40% to >40%. Participants were randomized to 10 mg dapagliflozin or placebo daily and the primary outcome of the trial was a composite of cardiovascular death or worsening heart failure (heart failure hospitalization or an urgent heart failure visit). Participants with HFimpEF had similar event rates to those with an EF consistently >40%. In participants with HFimpEF, dapagliflozin reduced the primary composite outcome (hazard ratio (HR) = 0.74, 95% confidence interval (CI) = 0.56-0.97), first worsening heart failure events (HR = 0.78, 95% CI = 0.61-1.14), cardiovascular death (HR = 0.62, 95% CI = 0.41-0.96) and total worsening heart failure events (rate ratio = 0.68, 95% CI = 0.50-0.94) to a similar extent as for individuals with an EF consistently >40%. These data suggest that patients with HFimpEF who are symptomatic may benefit from the addition of a sodium/glucose cotransporter 2 inhibitor to previously instituted guideline-directed medical therapy to further reduce morbidity and mortality.

Full Text

Duke Authors

Cited Authors

  • Vardeny, O; Fang, JC; Desai, AS; Jhund, PS; Claggett, B; Vaduganathan, M; de Boer, RA; Hernandez, AF; Lam, CSP; Inzucchi, SE; Martinez, FA; Kosiborod, MN; DeMets, D; O'Meara, E; Zieroth, S; Comin-Colet, J; Drozdz, J; Chiang, C-E; Kitakaze, M; Petersson, M; Lindholm, D; Langkilde, AM; McMurray, JJV; Solomon, SD

Published Date

  • December 2022

Published In

Volume / Issue

  • 28 / 12

Start / End Page

  • 2504 - 2511

PubMed ID

  • 36522606

Pubmed Central ID

  • PMC9800271

Electronic International Standard Serial Number (EISSN)

  • 1546-170X

Digital Object Identifier (DOI)

  • 10.1038/s41591-022-02102-9


  • eng

Conference Location

  • United States