Article Impact Level: HIGH Data Quality: STRONG Summary of Circulation, CIRCULATIONAHA.122.062918. https://doi.org/10.1161/CIRCULATIONAHA.122.062918 Dr. Toru Kondo et al.
Points
- The study aimed to compare patient characteristics and outcomes according to the duration of heart failure (HF) in individuals with mildly reduced or preserved ejection fraction and to examine the efficacy and safety of dapagliflozin across HF duration categories.
- HF duration was categorized as ≤6 months, >6 to 12 months, >1 to 2 years, >2 to 5 years, or >5 years, and outcomes were analyzed using Cox regression adjusted for prognostic variables.
- Patients with longer-duration HF were older, had more comorbidities and symptoms, and had higher rates of worsening HF and death. The rate of the primary outcome (per 100 person-years) increased with HF duration.
- The benefit of dapagliflozin was consistent across the HF duration category, with the absolute benefit being most significant in longest-duration HF. The number needed to treat HF >5 years was 24 versus 32 for ≤6 months.
- The study concludes that even patients with long-standing HF and generally mild symptoms are unstable, and dapagliflozin could benefit such patients.
Summary
The study aimed to investigate how patient characteristics and outcomes vary according to the duration of heart failure (HF) in individuals with mildly reduced or preserved ejection fraction and to compare the efficacy and safety of dapagliflozin across different durations of HF. The study was conducted as a prespecified analysis of the DELIVER trial. HF duration was categorized into five groups, ranging from ≤6 months to >5 years. The primary outcome was the composite of worsening HF or cardiovascular death, and the effect of dapagliflozin was examined by HF duration category.
The study included a total of 6,256 patients, with 1160 (18.5%) in the ≤6 months group, 842 (13.5%) in the >6 to 12 months group, 995 (15.9%) in the >1 to 2 years group, 1569 (25.1%) in the >2 to 5 years group, and 1692 (27.0%) in the >5 years group. Patients with longer-duration HF were older, had more comorbidities, and had worse symptoms. The rate of the primary outcome (per 100 person-years) increased with HF duration, with the highest rate seen in patients with HF >5 years: ≤6 months, 7.3 (95% CI, 6.3 to 8.4); >6 to 12 months, 7.1 (6.0 to 8.5); >1 to 2 years, 8.4 (7.2 to 9.7); >2 to 5 years, 8.9 (7.9 to 9.9); and >5 years, 10.6 (9.5 to 11.7). Similar trends were seen for other outcomes.
The benefit of dapagliflozin was consistent across all HF duration categories. The hazard ratio for the primary outcome in the ≤6-month group was 0.67 (95% CI, 0.50 to 0.91); >6 to 12 months, 0.78 (0.55 to 1.12); >1 to 2 years, 0.81 (0.60 to 1.09); >2 to 5 years, 0.97 (0.77 to 1.22); and >5 years, 0.78 (0.64 to 0.96; Pinteraction=0.41). The absolute benefit was most significant in patients with the longest-duration HF, with a number needed to treat 24 versus 32 for ≤6 months.
The study suggests that even patients with long-standing HF and generally mild symptoms are not stable. It is not too late for such patients to benefit from a sodium–glucose cotransporter 2 inhibitor. The findings of this study provide important insights into the management of HF and may help guide clinical decision-making.
Link to the article: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.062918
References Kondo, T., Jering, K. S., Borleffs, C. J. W., De Boer, R. A., Claggett, B. L., Desai, A. S., Dobreanu, D., Inzucchi, S. E., Hernandez, A. F., Janssens, S. P., Jhund, P., Kosiborod, M. N., Lam, C. S. P., Langkilde, A. M., Martinez, F. A., Petersson, M., Vinh, P. N., Vaduganathan, M., Solomon, S. D., & McMurray, J. J. V. (2023). Patient characteristics, outcomes, and effects of dapagliflozin according to the duration of heart failure: A prespecified analysis of the deliver trial. Circulation, CIRCULATIONAHA.122.062918. https://doi.org/10.1161/CIRCULATIONAHA.122.062918
