Article Impact Level: HIGH
Data Quality: STRONG
Summary of European Heart Journal, 43(41), 4406–4417. https://doi.org/10.1093/eurheartj/ehac481
Circulation, 146(16), 1210–1224. https://doi.org/10.1161/CIRCULATIONAHA.122.061754
Circulation, 146(16), 1193–1195. https://doi.org/10.1161/CIRCULATIONAHA.122.062022
New England Journal of Medicine, 387(12), 1138–1140. https://doi.org/10.1056/NEJMe2210177
Journal of the American College of Cardiology, 80(19), 1785–1787. https://doi.org/10.1016/j.jacc.2022.09.008
New England Journal of Medicine, 387(12), 1089–1098. https://doi.org/10.1056/NEJMoa2206286
Journal of the American College of Cardiology, 80(19), 1775–1784. https://doi.org/10.1016/j.jacc.2022.08.745
Dr. Muthiah Vaduganathan et al

Points

• The DELIVER study demonstrated that dapagliflozin, regardless of a diabetic condition, is more effective than placebo in enhancing heart failure outcomes in patients with clinically stable modestly decreased or maintained LVEF with an ejection fraction of more than forty percent.
• Every fragility and Body Mass Index category examined the same improvement from dapagliflozin. 
• Dapagliflozin caused a rapid boost in wellness and quality lifestyle, which was more pronounced in individuals who were more fragile and had a higher Body Mass Index.

Summary

Regardless of the presence or absence of diabetes, the investigation’s objective was to evaluate the protection and effectiveness of dapagliflozin in individuals with left ventricular ejection fraction above forty percent. 

The participants were divided into two categories. One group received Dapagliflozin 10 mg and had 3131 participants; the second was a control group with 3132 participants.  Each participant in the trial received the proper medical assistance for heart failure. The inclusion criterion was based on four basic categories: one was individuals above forty years of age, the second was those with a full-proof structural heart disorder, the third was those with average ejection fraction above forty, and the fourth was those with higher B-type natriuretic peptide. 

Benefits were seen as a decrease in heart failure hospitalizations, not in the death rate. The findings of the EMPA-REG OUTCOME, EMPEROR-Reduced, DAPA-HF, SCORED, SOLOIST, and other studies demonstrated a pronounced advantage in the treatment of heart failure even though the sodium-glucose cotransporter 2 (SGLT2) inhibitors were first marketed as Type 2 diabetes mellitus managing medicines.

This experiment, which recruited individuals with near normal or normal ejection fractions, is similar to the EMPEROR-Preserved trial, demonstrating a significant advantage in this clinical setting, regardless of diabetic type.

SGLT2 inhibitors among individuals with a major heart defect and preserved ejection fraction (HFpEF) are advised as a Class IIA, Level B strategy in the most recent American Heart Association recommendations. Even though they are both subgroup analyses, an attenuation of effect among patients with ejection fraction above sixty percent was not noticed in the present trial. Most commonly prescribed medications for cardiovascular disorders with reduced ejection fraction do not help treat reduced ejection fraction. And some medications, such as candesartan, spironolactone, and sacubitril/valsartan, seem to be more helpful in patients with ejection fractions between forty and forty-nine percent than with truly preserved ejection fractions. However, uncertainty surrounds the precise benefit mechanism.

Links to the articles:
https://www.jacc.org/doi/10.1016/j.jacc.2022.08.745
https://www.jacc.org/doi/10.1016/j.jacc.2022.09.008
https://academic.oup.com/eurheartj/article/43/41/4406/6674666
https://www.nejm.org/doi/full/10.1056/NEJMoa2206286
https://www.nejm.org/doi/full/10.1056/NEJMe2210177
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.061754
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.062022

References

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Margulies, K. B. (2022). Delivering progress in heart failure with preserved ejection fraction. New England Journal of Medicine, 387(12), 1138–1140. https://doi.org/10.1056/NEJMe2210177
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