ESC 2019 — DAPA-HF findings wow the crowd, showing dapagliflozin benefit with or without diabetes


  • Emily Willingham, PhD
  • Conference Reports
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Takeaway

  • In potentially practice-changing results from DAPA-HF, the sodium-glucose cotransporter 2 inhibitor (SGLT2i) dapagliflozin is tied to reduced cardiovascular (CV) death and heart failure (HF) hospitalization in patients with HF with reduced ejection fraction (HFrEF), regardless of diabetes status. 
  • Announcement of the results in a European Society of Cardiology (ESC) 2019 “Hot Line Session” elicited spontaneous audience applause.

Why this matters

  • Session discussant Marco Metra of the University of Brescia, Italy, said that the results herald “a new era in heart failure treatment,” with an expansion of dapagliflozin and possibly other drugs of its class from HF prevention to treatment.

Results

  • Median follow-up, 18.2 months.
  • Primary composite of worse HF (e.g., hospitalization) or CV mortality:  
    • 16.3% dapagliflozin vs 21.2% placebo.
    • HR, 0.74 (95% CI, 0.65-0.85; P<.00001>
  • Components separately, with dapagliflozin vs placebo:
    • Worsening HF: 10.0% dapagliflozin vs 13.7% placebo.
      • HR, 0.70 (95% CI, 0.59-0.83; P<.00004>
    • CV death: 9.6% dapagliflozin vs 11.5% placebo;
      • HR, 0.82 (95% CI, 0.69-0.98; P=.029).
  • The authors say relative and absolute risks were similar with and without diabetes, e.g. (HRs, 95% CIs):
    • Primary endpoint with diabetes: 0.75 (0.63-0.90).
    • Without: 0.73 (0.60-0.88).
  • Side effects did not differ significantly between groups.

Study design

  • Randomized controlled international trial, 4744 patients with HFrEF randomly allocated to 10 mg/day dapagliflozin or placebo.
  • Funding: AstraZeneca.

Limitations

  • Presented at a conference without peer review.

Additional note

  • Related but separately presented at ESC 2019: a new clinical calculator for HF hospitalization risk, dubbed the TRS-HFDM (TIMI Risk Score for HF in Diabetes), for identifying patients with type 2 diabetes who might get maximal benefit from SGL2is, validated in 2 large clinical trial cohorts.