Cited by 531Heart Failure Treatment and ManagementDiabetes Treatment and ManagementCardiovascular Function and Risk Factors

Effect of Dapagliflozin on Worsening Heart Failure and Cardiovascular Death in Patients With Heart Failure With and Without Diabetes

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Petrie, Mark C., Verma, Subodh, Docherty, Kieran F., Inzucchi, Silvio E., Anand, Inder, Belohlávek, Jan, Böhm, Michael, Chiang, Chern-En +31 more·2020·JAMA

Abstract

Importance: Additional treatments are needed for heart failure with reduced ejection fraction (HFrEF). Sodium-glucose cotransporter 2 (SGLT2) inhibitors may be an effective treatment for patients with HFrEF, even those without diabetes. Objective: To evaluate the effects of dapagliflozin in patients with HFrEF with and without diabetes. Design, Setting, and Participants: Exploratory analysis of a phase 3 randomized trial conducted at 410 sites in 20 countries. Patients with New York Heart Association classification II to IV with an ejection fraction less than or equal to 40% and elevated plasma N-terminal pro B-type natriuretic peptide were enrolled between February 15, 2017, and August 17, 2018, with final follow-up on June 6, 2019. Interventions: Addition of once-daily 10 mg of dapagliflozin or placebo to recommended therapy. Main Outcomes and Measures: The primary outcome was the composite of an episode of worsening heart failure or cardiovascular death. This outcome was analyzed by baseline diabetes status and, in patients without diabetes, by glycated hemoglobin level less than 5.7% vs greater than or equal to 5.7%. Results: Among 4744 patients randomized (mean age, 66 years; 1109 [23%] women; 2605 [55%] without diabetes), 4742 completed the trial. Among participants without diabetes, the primary outcome occurred in 171 of 1298 (13.2%) in the dapagliflozin group and 231 of 1307 (17.7%) in the placebo group (hazard ratio, 0.73 [95% CI, 0.60-0.88]). In patients with diabetes, the primary outcome occurred in 215 of 1075 (20.0%) in the dapagliflozin group and 271 of 1064 (25.5%) in the placebo group (hazard ratio, 0.75 [95% CI, 0.63-0.90]) (P value for interaction = .80). Among patients without diabetes and a glycated hemoglobin level less than 5.7%, the primary outcome occurred in 53 of 438 patients (12.1%) in the dapagliflozin group and 71 of 419 (16.9%) in the placebo group (hazard ratio, 0.67 [95% CI, 0.47-0.96]). In patients with a glycated hemoglobin of at least 5.7%, the primary outcome occurred in 118 of 860 patients (13.7%) in the dapagliflozin group and 160 of 888 (18.0%) in the placebo group (hazard ratio, 0.74 [95% CI, 0.59-0.94]) (P value for interaction = .72). Volume depletion was reported as an adverse event in 7.3% of patients in the dapagliflozin group and 6.1% in the placebo group among patients without diabetes and in 7.8% of patients in the dapagliflozin group and 7.8% in the placebo group among patients with diabetes. A kidney adverse event was reported in 4.8% of patients in the dapagliflozin group and 6.0% in the placebo group among patients without diabetes and in 8.5% of patients in the dapagliflozin group and 8.7% in the placebo group among patients with diabetes. Conclusions and Relevance: In this exploratory analysis of a randomized trial of patients with HFrEF, dapagliflozin compared with placebo, when added to recommended therapy, significantly reduced the risk of worsening heart failure or cardiovascular death independently of diabetes status. Trial Registration: ClinicalTrials.gov Identifier: NCT03036124.

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Authors
Petrie, M. C., Verma, S., Docherty, K. F., Inzucchi, S. E., Anand, I., Belohlávek, J., Böhm, M., Chiang, C.-E., Chopra, V. K., de Boer, R. A., Desai, A. S., Diez, M., Drozdz, J., Dukát, A., Ge, J., Howlett, J., Katova, T., Kitakaze, M., Ljungman, C. E. A., Merkely, B., Nicolau, J. C., O'Meara, E., Vinh, P. N., Schou, M., Tereshchenko, S., Køber, L., Kosiborod, M. N., Langkilde, A. M., Martinez, F. A., Ponikowski, P., Sabatine, M. S., Sjöstrand, M., Solomon, S. D., Johanson, P., Greasley, P. J., Boulton, D., Bengtsson, O., Jhund, P. S., & McMurray, J. J. V.
Affiliations
  • University of Glasgow (GB)
  • St. Michael's Hospital (CA)
  • Yale University (US)
  • University of Minnesota (US)
  • Second Department of Internal Medicine, Cardiovascular Medicine, General Teaching Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
  • Universitätsklinikum des Saarlandes (DE)
  • Taipei Veterans General Hospital (TW)
  • Department of Cardiology, Medanta, Gurgaon, Haryana, India
  • Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
  • Brigham and Women's Hospital (US)
  • Division of Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
  • Department Cardiology, Medical University of Lodz, Lodz, Poland
  • Comenius University Bratislava (SK)
  • Fudan University (CN)
  • University of Calgary (CA)
  • National Heart Hospital (BG)
  • National Cerebral and Cardiovascular Center (JP)
  • University of Gothenburg (SE)
  • Semmelweis University (HU)
  • Instituto do Coracao (InCor), Hospital das Clínicas Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
  • Department of Cardiology, Montreal Heart Institute, Montreal, Ontario, Canada
  • Department of Internal Medicine, Tan Tao University, Tan Duc, Vietnam
  • Gentofte Hospital (DK)
  • National Medical Research Center of Cardiology (RU)
  • Copenhagen University Hospital (DK)
  • University of Missouri–Kansas City (US)
  • AstraZeneca (Sweden) (SE)
  • Universidad Nacional de Córdoba, Córdoba, Argentina
  • Wroclaw Medical University (PL)
  • AstraZeneca (United States) (US)
Corresponding author
McMurray, John J. V.
Venue
JAMA
Published
2020-04-14
Volume
323
Issue
14
Pages
1353
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
OpenAlex
W3013838418
Cited by
531
References
32
Citations by year
2026: 37 · 2025: 46 · 2024: 75 · 2023: 90 · 2022: 103 · 2021: 124 · 2020: 53
FWCI
57.35
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion, cc-by-sa)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
Funders
  • Amgen
  • Bristol-Myers Squibb
  • Eli Lilly and Company
  • Pfizer
  • AstraZeneca (RE/18/6/34217)
  • GlaxoSmithKline
  • Sanofi
  • Brigham and Women's Hospital
  • Gilead Sciences
  • Alnylam Pharmaceuticals
  • Celladon Corporation
  • Ironwood Pharmaceuticals, Incorporated
  • Intarcia Therapeutics
  • Amarin Corporation
  • Cytokinetics
  • IFM Therapeutics
  • MyoKardia
  • Impulse Dynamics
  • Zora Biosciences
  • British Heart Foundation (18/6/34217, RE/18/6/34217)
  • Kidney Research UK
  • Daiichi-Sankyo
  • Eisai
  • Vifor Pharma
  • Servier
  • Esperion Therapeutics
  • National Institutes of Health
  • Sanofi Pasteur
  • Respicardia
  • National Heart, Lung, and Blood Institute
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK045735)
  • Janssen Research and Development
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Keywords
dapagliflozin, heart failure with reduced ejection fraction, SGLT2 inhibitors, worsening heart failure, cardiovascular mortality, diabetes mellitus, HbA1c, N-terminal pro-brain natriuretic peptide, ejection fraction, glycemic control, heart failure with preserved ejection fraction, subgroup analysis
MeSH terms
Sodium-Glucose Transporter 2 Inhibitors, Aged, Benzhydryl Compounds, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Double-Blind Method, Female, Glucosides, Heart Failure, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Male, Middle Aged, Placebos, Stroke Volume, Ventricular Dysfunction, Left

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