Dapagliflozin improves outcomes in heart failure among frail patients

Adjunctive dapagliflozin therapy appears to improve outcomes in heart failure patients without regard to frailty status at initiation of treatment.

These findings appeared on April 26, 2022 in the Annals of Internal Medicine.

“Dapagliflozin improved all outcomes examined, regardless of frailty status. However, the absolute reductions were larger in more frail patients,” the authors said.

The investigators enrolled 4744 subjects with symptomatic heart failure (HF) and left ventricular ejection fraction of 40% or less, plus elevated natriuretic peptide. Of these subjects, 4742 had a calculable frailty index.

In addition to guideline recommended treatment, the researchers added adjunctive once-daily 10mg dapagliflozin or placebo.

The primary outcome was worsening heart failure or cardiovascular death.

Of the total study population, 2392 (50.4%) were in the not frail group, 1606 (33.9%) were in the more frail group and 744 (15.7%) were in the most frail group.

Median follow-up was 18.2 months.

The investigators reported that dapagliflozin adjunctive therapy reduced the risk in all frailty groups of worsening heart failure or cardiovascular death.

The differences in the event rate per 100 years for dapagliflozin versus placebo were 3.5 for the not frail group, 3.6 for the more frail group and, notably, 7.9 for the most frail group. Adverse events related to dapagliflozin treatment were not higher than for placebo.

The authors noted one limitation of the study: “Enrollment criteria precluded the inclusion of very high risk patients.”