Publications
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Decline in Estimated Glomerular Filtration Rate After Dapagliflozin in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Prespecified Secondary Analysis of the DELIVER Randomized Clinical Trial
JAMA Cardiol. 2023; online ahead of print DOI: 10.1001/jamacardio.2023.4664
An initial decline in eGFR often occurs after initiating a SGLT2i and has been observed in patients with diabetes, CKD and HF. A prespecified analysis of DELIVER evaluated the magnitude and frequency of an initial decline in eGFR (within the first month) and its association with CV and renal outcomes in 5,788 patients with HFpEF or HFmrEF.
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Patient Characteristics, Outcomes, and Effects of Dapagliflozin According to the Duration of Heart Failure: A Prespecified Analysis of the DELIVER Trial
Circulation 2023; online ahead of print DOI: 10.1161/CIRCULATIONAHA.122.062918
Whether the efficacy and safety of SGLT2i therapy are maintained with increasing duration of HFmrEF or HFpEF is unknown. In this prespecified analysis of DELIVER, HF duration was categorised as ≤6 months, >6 to 12 months, >1 to 2 years, >2 to 5 years, or >5 years.
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Efficacy and Safety of Dapagliflozin in Patients with Heart Failure with Mildly Reduced or Preserved Ejection Fraction by Baseline Glycaemic Status (DELIVER): a Subgroup Analysis from an International, Multicentre, Double-blind, Randomised, Placebo-controlled Trial
Lancet Diabetes Endocrinol. 2022;10:869–881 DOI: 10.1016/S2213-8587(22)00308-4
Dapagliflozin was shown to be highly efficacious in patients with HFmrEF and HFpEF in the DELIVER trial. However, whether the benefits of dapagliflozin are observed across glycaemia categories has not been previously reported.
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Time to Clinical Benefit of Dapagliflozin in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Prespecified Secondary Analysis of the DELIVER Randomized Clinical Trial
JAMA Cardiol. 2022; online ahead of print DOI: 10.1001/jamacardio.2022.3750
Dapagliflozin was recently shown to reduce CV death or worsening HF events in patients with HF with mildly reduced or preserved ejection fraction in the DELIVER trial. This prespecified secondary analysis of DELIVER examined the timeline to onset of clinical benefit with dapagliflozin.
Effect of Dapagliflozin on Cause-Specific Mortality in Patients With Heart Failure Across the Spectrum of Ejection Fraction: A Participant-Level Pooled Analysis of DAPA-HF and DELIVER
JAMA Cardiol. 2022; online ahead of print DOI: 10.1001/jamacardio.2022.3736
In a prospective, patient-level pooled meta-analysis of the DAPA-HF and DELIVER trials, dapagliflozin-associated reductions in CV mortality in patients with HF appeared to be principally due to lower rates of sudden death and HF death, regardless of EF.
Efficacy and Safety of Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction According to Age: The DELIVER Trial
Circ Heart Fail. 2022 DOI: 10.1161/CIRCHEARTFAILURE.122.010080
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Dapagliflozin in Patients Recently Hospitalized With Heart Failure and Mildly Reduced or Preserved Ejection Fraction
J Am Coll Cardiol. 2022; online ahead of print DOI: 10.1016/j.jacc.2022.07.021
This prespecified analysis of the DELIVER trial found that dapagliflozin had beneficial effects on cardiovascular (CV) outcomes in patients with heart failure (HF) with mildly reduced or preserved left ventricular ejection fraction (LVEF) who were enrolled during or following hospitalisation.
Dapagliflozin across the range of ejection fraction in patients with heart failure: a patient-level, pooled meta-analysis of DAPA-HF and DELIVER
Nat Med. 2022; online ahead of print DOI: 10.1038/s41591-022-01971-4
In a prospective, patient-level pooled meta-analysis of the DAPA-HF and DELIVER trials, dapagliflozin was found to improve clinical outcomes across the range of LVEF.
Empagliflozin Improves Outcomes in Patients With Heart Failure and Preserved Ejection Fraction Irrespective of Age
J Am Coll Cardiol 2022;80(1):1-18 doi: 10.1016/j.jacc.2022.04.040
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce cardiovascular death and hospitalisation for heart failure (HHF) in patients with HFpEF, and are recommended in recent guidelines for heart failure with reduced ejection fraction (HFrEF), supported by Class IA evidence. Typically, HFpEF patients are older than HFrEF, and have a higher mortality risk associated with older age, while the risk for cardiovascular death is lower than in HFrEF. Until now, the treatment effects and safety of SGLT2i in relation to age have not been studied. This prespecified analysis of the EMPEROR-Preserved trial examined the interplay of age and empagliflozin treatment effects.
For patients on placebo, the incidence of primary outcomes and cardiovascular death increased with age. In contrast, empagliflozin reduced the primary outcome, first HHF, and first and recurrent HHF across all age groups. Empagliflozin also improved health-related quality of life, and attenuated the decline of eGFR without age interaction. Additionally, there were no clinically relevant differences in AEs between empagliflozin and placebo across the age groups, and elderly patients tolerated the treatment well.
Oral Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes
N Engl J Med 2019;381:841–51 DOI 10.1056/NEJMoa1901118
In the PIONEER 6 trial, the cardiovascular risk profile of oral semaglutide was noninferior to placebo over 83 weeks.