Cited by 7,140Heart Failure Treatment and ManagementDiabetes Treatment and ManagementCardiovascular Function and Risk Factors

The DOI matches its Crossref record; 21 of the 21 references it cites were found in a registry or an index.

Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction

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Abstract

BACKGROUND: In patients with type 2 diabetes, inhibitors of sodium-glucose cotransporter 2 (SGLT2) reduce the risk of a first hospitalization for heart failure, possibly through glucose-independent mechanisms. More data are needed regarding the effects of SGLT2 inhibitors in patients with established heart failure and a reduced ejection fraction, regardless of the presence or absence of type 2 diabetes. METHODS: In this phase 3, placebo-controlled trial, we randomly assigned 4744 patients with New York Heart Association class II, III, or IV heart failure and an ejection fraction of 40% or less to receive either dapagliflozin (at a dose of 10 mg once daily) or placebo, in addition to recommended therapy. The primary outcome was a composite of worsening heart failure (hospitalization or an urgent visit resulting in intravenous therapy for heart failure) or cardiovascular death. RESULTS: Over a median of 18.2 months, the primary outcome occurred in 386 of 2373 patients (16.3%) in the dapagliflozin group and in 502 of 2371 patients (21.2%) in the placebo group (hazard ratio, 0.74; 95% confidence interval [CI], 0.65 to 0.85; P<0.001). A first worsening heart failure event occurred in 237 patients (10.0%) in the dapagliflozin group and in 326 patients (13.7%) in the placebo group (hazard ratio, 0.70; 95% CI, 0.59 to 0.83). Death from cardiovascular causes occurred in 227 patients (9.6%) in the dapagliflozin group and in 273 patients (11.5%) in the placebo group (hazard ratio, 0.82; 95% CI, 0.69 to 0.98); 276 patients (11.6%) and 329 patients (13.9%), respectively, died from any cause (hazard ratio, 0.83; 95% CI, 0.71 to 0.97). Findings in patients with diabetes were similar to those in patients without diabetes. The frequency of adverse events related to volume depletion, renal dysfunction, and hypoglycemia did not differ between treatment groups. CONCLUSIONS: Among patients with heart failure and a reduced ejection fraction, the risk of worsening heart failure or death from cardiovascular causes was lower among those who received dapagliflozin than among those who received placebo, regardless of the presence or absence of diabetes. (Funded by AstraZeneca; DAPA-HF ClinicalTrials.gov number, NCT03036124.).

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Authors
McMurray, J. J. V., Solomon, S. D., Inzucchi, S. E., Køber, L., Kosiborod, M. N., Martinez, F. A., Ponikowski, P., Sabatine, M. S., Anand, I. S., Bělohlávek, 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. G., Katova, T., Kitakaze, M., Ljungman, C. E. A., Merkely, B., Nicolau, J. C., O’Meara, E., Petrie, M. C., Vinh, P. N., Schou, M., Tereshchenko, S., Verma, S., Held, C., DeMets, D. L., Docherty, K. F., Jhund, P. S., Bengtsson, O., Sjöstrand, M., & Langkilde, A.-M.
Affiliations
  • Brigham and Women's Hospital (US)
  • From the BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (J.J.V.M., M.C.P., K.F.D., P.S.J.); the Cardiovascular Division (S.D.S., A.S.D.) and the TIMI Study Group, Brigham and Women’s Hospital and Harvard Medical School (M.S.S.) — all in Boston; Section of Endocrinology, Yale University School of Medicine, New Haven, CT (S.E.I.); Rigshospitalet Copenhagen University Hospital (L.K.) and the Department of Cardiology, Gentofte University Hospital (M. Schou),...
  • Semmelweis University (HU)
  • Uppsala University (SE)
Venue
New England Journal of Medicine
Published
2019-11-21
Volume
381
Issue
21
Pages
1995-2008
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2974260792
Cited by
7,140
References
21
Citations by year
2026: 842 · 2025: 955 · 2024: 979 · 2023: 1060 · 2022: 1138 · 2021: 1152 · 2020: 904 · 2019: 89
FWCI
593.03
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
  • Research Bank (Australian Catholic University) (submittedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
Funders
AstraZeneca Plc
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, SGLT2 inhibitors, heart failure with reduced ejection fraction, type 2 diabetes, cardiovascular mortality, heart failure hospitalization, hypovolemia, renal dysfunction, hypoglycemia, SGLT2 inhibition, heart failure prognosis, adverse events, glucose monitoring, heart failure with preserved ejection fraction
MeSH terms
Sodium-Glucose Transporter 2 Inhibitors, Aged, Benzhydryl Compounds, Cardiovascular Agents, Cardiovascular Diseases, Combined Modality Therapy, Diabetes Mellitus, Type 2, Drug Therapy, Combination, Female, Glucosides, Heart Failure, Glycated Hemoglobin, Hospitalization, Humans, Male, Middle Aged, Stroke Volume, Ventricular Dysfunction, Left, Kaplan-Meier Estimate

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