Assessing the efficacy and safety of dapagliflozin in patients with HFrEF


Background: Guideline-directed medical therapy (use of beta-blockers, ACE inhibitor/angiotensin receptor blockers, and mineralocorticoid antagonists) provides clear benefits on mortality and morbidity in patients with HFrEF. Dapagliflozin (Farxiga) belongs to a class of sodium-glucose transporter 2 (SGLT2) inhibitors that inhibits reabsorption of sodium and glucose in the kidney and treats type 2 diabetes. This new class of drugs is emerging as an effective tool in the management of HFrEF based on the recent publication of the primary results of the DAPA-HF trial (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients with Chronic Heart Failure). It demonstrated substantial benefits in terms of heart failure symptoms, hospitalizations, and mortality when added to triple therapy for patients with chronic HFrEF regardless of the presence of diabetes.

Dr. Ritu Garg

Study design: Randomized, controlled double-blind trials.

Setting: 410 participating institutions in 20 countries.

Synopsis: Men and women aged 18 years and older with HFrEF who had New York Heart Association (NYHA) functional class II or higher, and optimally treated with pharmacologic and device therapy for HF were randomized to receive dapagliflozin or placebo. A total of 4,744 patients, aged 22-94 years were enrolled in the study.

  • Dapagliflozin showed a clinically significant benefit on health status (symptoms, physical function, and quality of life). Improved health-related quality of life (as measured by the well-validated Kansas City Cardiomyopathy Questionnaire score) with dapagliflozin in comparison with placebo was sustained for more than 8 months.
  • Dapagliflozin reduced the risk of death and worsening heart failure and improved symptoms across the broad spectrum of ages studied in DAPA-HF. There was no significant imbalance in tolerability or safety events between dapagliflozin and placebo, even in elderly individuals.

Bottom line: Follow-up DAPA-HF studies further support the role of SGLT2 inhibitor dapagliflozin in improving mortality, reducing hospitalization, and improving the quality of life in patients with HFrEF and is considered a safe option across all age groups.

Citations: Kosiborod MN et al. Effects of dapagliflozin on symptoms, function, and quality of life in patients with heart failure and reduced ejection fraction: Results from the DAPA-HF trial. Circulation. 2020 Jan 14;141(2):90-9. Martinez FA et al. Efficacy and safety of dapagliflozin in heart failure with reduced ejection fraction according to age. Insights from DAPA-HF. Circulation. 2020 Jan 14;141:100-11.

Dr. Garg is assistant professor in the division of hospital medicine, Loyola University Medical Center, Maywood, Ill.

Recommended Reading

In-hospital mobility impairment in older MI patients predicts postdischarge functional decline
The Hospitalist
PCI and CABG for left main disease have equal outcomes at 5 years
The Hospitalist
The role of aspirin in primary prevention of cardiovascular disease
The Hospitalist
Longitudinal associations between income changes and incident CVD
The Hospitalist
AstraZeneca COVID vaccine: Clotting disorder mechanism revealed?
The Hospitalist
Novel antiplatelet drug: Hope for efficacy without bleeding?
The Hospitalist
Arthritis drug may curb myocardial damage in acute STEMI
The Hospitalist
How some COVID-19 vaccines could cause rare blood clots
The Hospitalist
How often should we check EKGs in patients starting antipsychotic medications?
The Hospitalist
Pneumonia risk soars in heart failure patients, especially HFpEF
The Hospitalist
   Comments ()