TY  - JOUR
AV  - public
EP  - 1258
IS  - 7
PB  - Wiley
N2  - AIMS:The aim of this study was to examine whether left ventricular ejection fraction (LVEF) modified efficacy and safety of dapagliflozin 10?mg compared with placebo in the 4744 patients with LVEF??40% randomized in the Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure trial (DAPA-HF). METHODS AND RESULTS:We examined whether LVEF, analysed categorically or continuously, modified the effect of dapagliflozin. The primary efficacy outcome was the composite of a worsening heart failure (HF) event (unplanned HF hospitalization/an urgent HF visit requiring intravenous therapy) or cardiovascular death. Mean LVEF was 31.1% and LVEF categories analysed were: <26% (n = 1143), 26-30% (n = 1018), 31-35% (n = 1187), and >35% (n = 1396). Each 5% decrease in LVEF was associated with a higher risk of the primary outcome [hazard ratio (HR) 1.18; 95% confidence interval (CI) 1.13-1.24]. The benefit of dapagliflozin was consistent across the spectrum of LVEF: the dapagliflozin vs. placebo HR was 0.75 (95% CI 0.59-0.95) for LVEF <26%, 0.75 (0.57-0.98) for LVEF 26-30%, 0.67 (0.51-0.89) for LVEF 31-35%, and 0.83 (0.63-1.09) for LVEF?>35% (P for interaction = 0.762). Similarly, the effect of dapagliflozin on the components of the primary endpoint was not modified by baseline LVEF (P for interaction for cardiovascular death = 0.974, and for worsening HF = 0.161). Safety of dapagliflozin was also consistent across the range of LVEF and neither efficacy nor safety were modified by diabetes status. CONCLUSION:Left ventricular ejection fraction was a significant predictor of hospitalization and mortality in patients with HF with reduced ejection fraction but did not modify the beneficial effect of dapagliflozin, overall or separately, in patients with and without diabetes. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov Identifier NCT03036124.
ID  - enlighten215693
VL  - 22
UR  - https://eprints.gla.ac.uk/215693/
Y1  - 2020/07//
A1  - Dewan, Pooja
A1  - Solomon, Scott D.
A1  - Jhund, Pardeep S.
A1  - Inzucchi, Silvio E.
A1  - Køber, Lars
A1  - Kosiborod, Mikhail N.
A1  - Martinez, Felipe A.
A1  - Ponikowski, Piotr
A1  - DeMets, David L.
A1  - Sabatine, Marc S.
A1  - Bengtsson, Olof
A1  - Sjo?strand, Mikaela
A1  - Langkilde, Anna Maria
A1  - Anand, Inder S.
A1  - Be?lohla?vek, Jan
A1  - Chopra, Vijay K.
A1  - Duka?t, Andrej
A1  - Kitakaze, Masafumi
A1  - Merkely, Be?la
A1  - O'Meara, Eileen
A1  - Schou, Morten
A1  - Vinh, Pham Nguyen
A1  - McMurray, John J.V.
JF  - European Journal of Heart Failure
TI  - Efficacy and safety of sodium?glucose co?transporter 2 inhibition according to left ventricular ejection fraction in DAPA?HF
SP  - 1247
SN  - 1388-9842
ER  -